08Lec-COMPLICATIONS OF PNEUMONIA.pdf - Pediatric Infectious ...

(%)Lethargy 31Yen et al(n+23)9187352622Lung abscess in children.Patradoon-Ho P, et al. Paediatr Respir Rev 2007Symptoms (%) Children’sHosp, Sydney (n=23) Tan, et al(n=25) Chan et al(n=27) Yen et al(n=23)Fever 83 84 100 91Cough 65 53 67 87Dyspnea 36 35 19 35Cheat pain 24 22 9Anorexia/ Nauseaand Vomiting 24 20 4 26Malaise and31 11 NR 22Lung Abscess: EvaluationDiagnosis:Chest X-Ray: solitary, thick-walled cavity in thelung with or without air fluid levelUltrasonography and CT scan: to localize thelesion and guide drainage or needle aspiration.Direct percutaneous aspiration is the mostreliable mode of identification of the etiologicagent.Lung Abscess: Antimicrobial Treatment• Overall outcome is good, with mortality rateslower than those in adults.• Up to 90% of patients with lung abscess may beadequately treated with intravenous antibiotictherapy.• The choice of antibiotic is usually empiric basedon the underlying condition of the patient and thepresumed etiologic agent(s).• The duration of parenteral treatment varies from 5days (Patradoon-Ho 2007) to 3 weeks (Tan 1995),followed by oral therapy.2007 Patradoon-HoLung Abscess: Surgical Treatment• Surgical management is considered in cases oflarge lung abscess especially when associatedwith hemoptysis.• Surgical management is indicated if there isclinical deterioration despite appropriateantibiotic therapy.1. Drainage via bronchoscopy2. Percutaneous tube drainage3. Percutaneous needle aspiration4. LobectomyLobectomy or wedge resection should be reservedfor massive expansion of the abscess associatedwith mediastinal shift and attendant symptoms.