Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.
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The Diagnostic Imperative and Methodology
Diagnosing a lung abscess involves two main steps: first, confirming there is a cavity in the lung, and second, finding out what caused it and if there are any other problems. Lung abscesses are often mistaken for other conditions like empyema, tuberculosis, or cancer. At Liv Hospital, we use a fast, thorough approach with scans, lab tests, and sometimes procedures to make sure we get the right diagnosis, since treatment can be very different for each condition.
A chest X-ray is the first test done for anyone with symptoms like cough, fever, or coughing up blood.
A chest CT scan with contrast is almost always done at Liv Hospital to get a clearer diagnosis.
Finding the exact germ causing the abscess is important for choosing the right antibiotics, but sputum samples are often mixed with normal mouth bacteria and can be misleading.
Bronchoscopy involves passing a flexible camera into the lungs to visualize the airways. It is not routine for every abscess, but it is mandatory in specific high risk scenarios.
For peripheral abscesses where bronchoscopy is non diagnostic, and the patient is deteriorating, a needle aspiration through the chest wall, performed under CT or ultrasound guidance, can obtain pus for definitive culture. This procedure carries a risk of pneumothorax or of pus entering the pleural space, leading to an empyema, so it is considered a second-line diagnostic tool reserved for complex cases.
The clinician must rigorously rule out other conditions that can mimic a lung abscess.
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The CT scan is necessary to measure the cavity precisely, ensure it is not a fluid collection outside the lung known as an empyema, and most importantly, to check for a tumor blocking the airway that caused the infection.
It is a safe procedure done under sedation. The main risks are minor bleeding or temporary low oxygen levels, but it provides crucial information about why the abscess formed, such as a hidden foreign body or cancer.
It can not be easy. Cancer cavities often have thicker, lumpier walls. We treat with antibiotics first and repeat imaging; if the abscess does not shrink, we biopsy it to rule out cancer.
Because the sputum has to pass through your mouth, it picks up all the mouth bacteria on the way out. This makes it hard to tell which bacteria came from the lung infection and which are just normal mouth flora.
It is a straight horizontal line seen on an X-ray. It implies a hollow space or cavity containing both liquid pus and air, a classic sign that the lung tissue has been destroyed and drained.
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