inflammatory circumscribed focus (nidus) which evolves towards necrosis and excavation→ bronchorrhea

• primary→ pneumonia, bronchoaspiration, PE
• secondary→ bronchial obstruction

1. Aspiration of oropharyngeal content→ states of unconciousness, deglutition disorders, Obstruction, Ileus, Vomiting, ENT/Dental Interventions
2. Hematogenous dissemination
3. Pre-existing lung diseases→ischemia,necrosis
4. Immune deficiencies
5. Infected thorax wounds

• #1 by direct inhalation - bronchial
• check for obstruction!
• parenchymal
• hematological dissemination (vasculary)
• point of entry→ ENT/ Dental/ CUtaneous

• non-specific: fever, asthenia, weight loss
• cough
• purulent
• fecal-smelling (anerobe)

1. Building-Up phase/ Closed fester→ Pneumonia signs
2. Vomica phase→ exhibition of purulent, fetide and abundant sputum, fever decreases
3. Open fester phase→ alteration of general condition between periods of fever and abundant sputum with no fever/small amounts of sputum

• Cultures
• Sputum examination→ collect before starting AB Tx ‼️
• Biohumoral→ Leukocystosis, Procalcitonin, Glycemia

⇒ 📷

• hydroaeric levels.
• soft wall
• irregularity in hydroaeric levels in various examinations
• drainage bronchus (more visible on CT)

⇒ 📷

• excavations of existing:
‣
Lung cancer
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When do we suspect it?
• no history of aspiration
• no fever and sputum
• no answer to ABs
‣
How is the paraclinical workup?
• CXR
‣
What do we see in CXR?
⇒ 📷
• cavity progresses towards center→ necrosis
• irregular walls
• Cytologic examination of sputum
• Fibrobronchoscopy + biopsy→ if non-conclusive→ Thoracotomy
‣

pneumoconiotic lesion

→occupational exposure

• infectious:
‣

TB

‣

Where is the common location?

upper lobes

‣

How does the Chest X-Ray look like?

caverna. 📷

‣

How do we confirm?

microscopy + culture (BK+)

‣
Aspergilloma
‣
Where do we see it?
pre-existing cavities
→ evacuated hydatid cyst, emphysema air pockets
‣
How do we dg?
• Sputum (aspergillus +)
• CT or xray ⇒ 📷
• meniscal (”c-shaped) picture
• pre-exisiting cavities
‣

enysted Empyema

→ no inflammation signs around

‣

superinfected hydatid cyst

→ suspect in animal breeders (aka farmer fut)

→ ANTIBODIES IN SERUM

• asphyxating of vomica
• systemic spread
• septicemia→ brain, renal abscesses, DIC
• local spread
• contralateral pneumonia
• Hemoptysis
• Pleural empyema

• becomes chronic
• Bronchiectasis

• Infection Tx→ rapid, early, long-term
• Areal/ Causative treatment

after acute phase is over

• chronic lung abscess, non-responging to AB Tx>3 months
• irreversible obstruction
• abscess >6cm
• Hemoptysis
• Empyema

1. bronchiectassis
2. retractile plachypleuritis → restrictive resp. failure