![]() 1–4 Dyspnea due to an effusion can be quickly relieved by removal of the fluid, indicating the return of improved mechanics. ![]() Dyspnea appears to be caused by mechanical effects, either due to the expansion of the chest wall and muscles of breathing and/or due to the inversion of the diaphragm. Three common symptoms are associated with pleural effusion: dyspnea, cough, and chest pain. Courtney Broaddus MD, in Murray & Nadel's Textbook of Respiratory Medicine, 2022 Approach to Patients with Pleural Effusion However, when septic emboli are a possibility, especially in the setting of multiple abscesses, blood cultures and a transthoracic echocardiogram to evaluate for vegetations should be obtained. Blood cultures are not routinely recommended in those who do not have sepsis or septic shock. 50.4), serum markers (e.g., antineutrophil cytoplasmic antibodies ) should be obtained. The procedure should be considered early in those with an abscess greater than 4 cm because they have a higher risk of not responding to antibiotic therapy. It can also be helpful for drainage of abscesses that do not openly communicate with a bronchus. Transthoracic needle aspiration can provide a clean specimen for culture. Bronchoscopy with bronchoalveolar lavage is often considered early in immunocompromised patients, for whom evaluating opportunistic infections is a high priority. Outside of obtaining cultures, bronchoscopy can be used to evaluate the airways, biopsy a mass, or remove a foreign body if present. 9 Nonetheless, efforts should be made to recover a causative organism, and bronchoalveolar lavage samples should be sent for bacterial, mycobacterial, and fungal cultures. If the abscess is anerobic, bronchoscopy with bronchoalveolar lavage or quantitative brush catheter cultures may not recover the causative organism, because there are only a limited number of cases in which anaerobic organisms have been isolated. A thoracentesis should be performed if a pleural effusion exists because it provides an uncontaminated specimen that may represent the etiologic agent of an adjacent abscess. ![]() Procedures such as thoracentesis, bronchoscopy, and transthoracic needle aspiration may be warranted, especially if an individual is not improving with antibiotic therapy. 8 For optimal results, samples should be obtained and submitted to the microbiology laboratory prior to initiation of antibiotic therapy. Whether metagenomic sequencing can be useful in diagnosis and treatment decisions remains to be determined. Even with appropriate handling, samples may be contaminated by bacteria from the oral cavity. Because many anaerobic bacteria are rapidly killed by exposure to atmospheric oxygen, accurate results from anaerobic cultures require rapid transport and handling by the microbiology laboratory. When a pulmonary abscess is suspected, expectorated sputum should be sent for Gram stain and aerobic culture. Courtney Broaddus MD, in Murray & Nadel's Textbook of Respiratory Medicine, 2022 Diagnostic Studies ![]()
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