Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- presencia de factores de riesgo
- fiebre
- tos productiva
- ruidos respiratorios cavernosos (anfóricos)
Otros factores de diagnóstico
- soplo cardíaco
- dolor torácico pleurítico
- síntomas constitucionales
- caquexia
- palidez
- enfermedad gingival
- halitosis
- ausencia del reflejo faríngeo
- disnea
- hemoptisis
- escalofríos intensos
- debilidad
- artralgia
- lesiones hemorrágicas
- crepitantes inspiratorios
- respiración bronquial
- ruidos respiratorios reducidos
- roncus fijo unilateral
Factores de riesgo
- predisposición a la aspiración de contenido gástrico
- higiene dental deficiente y extracción de piezas dentales
- obstrucción bronquial
- inmunosupresión
- enfermedad crónica
- sepsis extrapulmonar
- neumonía
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- hemograma completo (HC)
- radiografía de tórax
- tinción de Gram del esputo
- cultivo de esputo
- hemocultivo
- cultivo del líquido de empiema
Pruebas diagnósticas que deben considerarse
- tomografía computarizada (CT) de tórax
- broncoscopia
- cultivos cuantitativos de muestras tomadas con cepillo protegido
- cultivos cuantitativos de muestras de lavado broncoalveolar protegido
- aspiración con aguja percutánea y cultivo
- citología de esputo
- ultrasonido de pulmón
- ecocardiograma
- ensayo inmunoenzimático rápido (ELISA) para el dímero D
- tomografía computarizada de tórax con detector múltiple
- gammagrafía de ventilación-perfusión
Algoritmo de tratamiento
probabilidad baja de microorganismos gramnegativos o resistentes a múltiples fármacos
probabilidad alta de microorganismos gramnegativos o resistentes a múltiples fármacos
probabilidad baja de microorganismos gramnegativos o resistentes a múltiples fármacos
alta probabilidad de microorganismos gramnegativos o resistentes a múltiples fármacos: con o sin alergia a penicilina/cefalosporina
Colaboradores
Autores
Ioannis P. Kioumis, MD, PhD
Professor of Respiratory Medicine and Infectious Diseases
Aristotle University of Thessaloniki
Respiratory Failure Clinic
General Hospital G. Papanikolaou
Thessaloniki
Greece
Declarações
IPK declares that he has no competing interests.
Georgia G. Pitsiou, MD, PhD
Professor of Respiratory Medicine
Aristotle University of Thessaloniki
Respiratory Failure Clinic
General Hospital G. Papanikolaou
Thessaloniki
Greece
Declarações
GGP declares that she has no competing interests.
Revisores
William G. Cheadle, MD
Professor of Surgery
University of Louisville
Associate Chief of Staff for Research and Development
VAMC Louisville
Louisville
KY
Declarações
WGC declares that he has no competing interests.
Nicholas Maskell, MD
Senior Lecturer and Consultant Physician
North Bristol Lung Centre
Southmead Hospital
Bristol
UK
Declarações
NM declares that he has no competing interests.
Najib Rahman, BM, BCh, MA (Oxon), MRCP (UK)
MRC Training Fellow and Specialist Registrar, Respiratory Medicine
Oxford Centre for Respiratory Medicine
Churchill Hospital
Oxford
UK
Declarações
NR declares that he has no competing interests.
Philip W. Ind, BA (Cantab), MB BChir, MA (Cantab), FRCP
Consultant Physician
Honorary Senior Lecturer
Imperial College Healthcare Trust
Hammersmith Hospital
London
UK
Declarações
PWI declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Walters J, Foley N, Molyneux M. Continuing education in anaesthesia, critical care and pain: pus in the thorax: management of empyema and lung abscess. 2011 Dec 1;11(6):229-33.Texto completo
American College of Radiology. ACR appropriateness criteria: radiologic management of infected fluid collections. 2019 [internet publication].Texto completo
American College of Radiology; Society of Interventional Radiology; Society for Pediatric Radiology. ACR-SIR-SPR practice guideline for specifications and performance of image-guided percutaneous drainage/aspiration of abscesses and fluid collections (PDAFC). 2023 [internet publication].Texto completo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Neoplasia (cáncer de pulmón primario o metastásico, linfoma)
- Tuberculosis
- Neumonía necrosante
Mais Diagnósticos diferenciaisDiretrizes
- Practice guideline for specifications and performance of image-guided percutaneous drainage/aspiration of abscesses and fluid collections (PDAFC)
- Appropriateness criteria: radiologic management of infected fluid collections
Mais Diretrizes
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