SFGH 4.26 pearls: TB and lung abscesses

  • As a reminder, placing patients with suspected TB on “high isolation” here means they will have a negative pressure room in addition to requiring an N-95 mask.
  • Remember that a TB abscess with pleural involvement is classified as extra-pulmonary TB and prolongs the treatment course with RIPE
  • Time to negative AFB varies greatly for TB patients started on RIPE depending on disease burden
    • When they can leave the hospital depends on where they will be staying after discharge – contact ID or TB clinic for help with this!
  • For lung abscesses with empyema, consulting thoracic surgery along with IR early on can help determine appropriate diagnostic and therapeutic management
    • Isolated lung abscesses can often be treated with a prolonged course of clindamycin with serial imaging to monitor progress, but initial treatment of abscesses with associated infiltrates or broad differential should include coverage for GNRs along with anaerobes.
  • Post-operative complications are by the far the most common cause of bronchopleural fistula, which is a very rare condition, but other etiologies include lung necrosis due to infection, persistent pneumothorax, radiation and TB.
    • Symptoms can mimic TB and include fever, productive cough and hemoptysis, though some patients may also have subcutaneous emphysema
    • Management options are limited and based mainly on post-op literature, but the two main strategies are mechanical plugs (with a balloon, gel foam, sclerosants, etc) and placement of a one-way valve.

 

Varoli F, Roviaro G, Grignani F, et al. Endoscopic treatment of bronchopleural fistulas. Ann Thorac Surg 1998; 65:807.

Lois M, Noppen M. Bronchopleural fistulas: an overview of the problem with special focus on endoscopic management. Chest 2005; 128:3955.

 

Evernote: https://www.evernote.com/shard/s300/sh/2a387777-53c6-4687-be00-b654c8b7eca9/310629bfb2409bd1ab83d4b7f6b691c2

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