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