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Abscesso pulmonar

Última revisão: 22 Jul 2025
Última atualização: 12 Dec 2023

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • presença de fatores de risco
  • febre
  • tosse produtiva
  • murmúrios vesiculares cavernosos (anfóricos)
Detalhes completos

Outros fatores diagnósticos

  • sopro cardíaco
  • dor torácica pleurítica
  • sintomas constitucionais
  • caquexia
  • palidez
  • doença gengival
  • halitose
  • ausência de reflexo faríngeo
  • dispneia
  • hemoptise
  • calafrios
  • fraqueza
  • artralgia
  • lesões hemorrágicas
  • estertores inspiratórios
  • sopro tubário
  • murmúrios vesiculares reduzidos
  • ronco fixo unilateral
Detalhes completos

Fatores de risco

  • predisposição à aspiração do conteúdo gástrico
  • má higiene dental e extração dentária
  • obstrução brônquica
  • imunossupressão
  • doença crônica
  • sepse extrapulmonar
  • pneumonia
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • Hemograma completo
  • radiografia torácica
  • coloração de Gram de expectoração
  • cultura de escarro
  • hemocultura
  • cultura do fluido do empiema
Detalhes completos

Investigações a serem consideradas

  • tomografia computadorizada (TC) do tórax
  • broncoscopia
  • culturas quantitativas de esfregaço do espécime protegido
  • culturas quantitativas de amostras da lavagem broncoalveolar protegida
  • aspiração por agulha percutânea e cultura
  • citologia do escarro
  • ultrassonografia do pulmão
  • ecocardiograma
  • ensaio de imunoadsorção enzimática (ELISA) rápido para dímero D
  • TC de tórax com multidetectores
  • cintilografia de ventilação/perfusão
Detalhes completos

Algoritmo de tratamento

AGUDA

baixa probabilidade de microrganismo gram-negativo ou multirresistente

alta probabilidade de microrganismo Gram-negativo ou multirresistente

CONTÍNUA

baixa probabilidade de microrganismo gram-negativo ou multirresistente

alta probabilidade de microrganismo gram-negativo ou multirresistente: com ou sem alergia à penicilina/cefalosporina

Colaboradores

Autores

Ioannis P. Kioumis, MD, PhD
Ioannis P. Kioumis

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
Georgia G. Pitsiou

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

Disclosures

WGC declares that he has no competing interests.

Nicholas Maskell, MD

Senior Lecturer and Consultant Physician

North Bristol Lung Centre

Southmead Hospital

Bristol

UK

Disclosures

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

Disclosures

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

Disclosures

PWI declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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.Full text

American College of Radiology. ACR appropriateness criteria: radiologic management of infected fluid collections. 2019 [internet publication].Full text

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].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Abscesso pulmonar images
  • Differentials

    • Neoplasia (câncer de pulmão primário ou metastático, linfoma)
    • Tuberculose
    • Pneumonia necrosante
    More Differentials
  • Guidelines

    • 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
    More Guidelines
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