| ICD-9-CM: |
| 006.3 - | Amebic Liver Abscess; Hepatic Amebiasis |
| 006.4 - | Amebic Lung Abscess; Amebic Abscess of Lung, Liver |
| 013.3 - | Tuberculous Abscess of Brain |
| 013.5 - | Tuberculous Abscess of Spinal Cord |
| 017.2 - | Tuberculosis of Peripheral Lymph Nodes; Scrofula; Scrofulous Abscess; Tuberculous adenitis |
| 254.1 - | Abscess of Thymus |
| 289.59 - | Diseases of Spleen, Other; Lien Migrans; Perisplenitis; Splenic Abscess, Atrophy, Cyst, Fibrosis, Infarction, Rupture, Nontraumatic; Splenitis; Wandering Spleen |
| 324 - | Abscess, Intracranial and Intraspinal |
| 324.0 - | Intracranial Abscess; Abscess (Embolic): Cerebellar, Cerebral; Abscess (Embolic) of Brain [Any Part]: Epidural, Extradural, Otogenic, Subdural |
| 324.1 - | Intraspinal Abscess; Abscess (Embolic) of Spinal Cord [Any Part]: Epidural; Extradural; Subdural |
| 326 - | Late Effects of Intracranial Abscess or Pyogenic Infection |
| 360.04 - | Vitreous Abscess |
| 370.55 - | Interstitial and Deep Keratitis; Corneal Abscess |
| 373.13 - | Abscess of Eyelid; Furuncle of Eyelid |
| 376.01 - | Orbital Cellulitis; Abscess of Orbit |
| 379.09 - | Scleritis and Episcleritis, Other; Scleral Abscess |
| 383.01 - | Subperiosteal Abscess of Mastoid |
| 475 - | Peritonsillar Abscess |
| 478.24 - | Retropharyngeal Abscess |
| 478.29 - | Diseases of Pharynx, Other, Not Elsewhere Classified, Other; Abscess of Pharynx or Nasopharynx |
| 478.79 - | Abscess, Larynx |
| 513 - | Abscess of Lung and Mediastinum |
| 513.0 - | Abscess of Lung |
| 513.1 - | Abscess of Mediastinum |
| 522.5 - | Periapical Abscess without Sinus |
| 522.7 - | Periapical Abscess with Sinus |
| 527.3 - | Diseases of the Salivary Glands; Abscess |
| 528.5 - | Diseases of Lips; Abscess of Lip(s); Cellulitis of Lip(s); Fistula of Lip(s); Hypertrophy of Lip(s), Angular; Cheilodynia; Cheilosis |
| 529.0 - | Glossitis; Abscess of Tongue; Ulceration (Traumatic) of Tongue |
| 540.1 - | Appendicitis, Acute with Peritoneal Abscess |
| 566 - | Abscess of Anal and Rectal Regions |
| 567.2 - | Abscess, Subdiaphragmatic |
| 569.5 - | Abscess of Intestine |
| 572 - | Liver Abscess and Sequelae of Chronic Liver Disease |
| 572.0 - | Liver Abscess and Sequelae of Chronic Liver Disease, Liver Abscess |
| 590.2 - | Renal and Perinephric Abscess; Abscess: Kidney, Nephritic, Perirenal; Carbuncle of Kidney |
| 601.2 - | Abscess of Prostate |
| 611.0 - | Disorders of Breast, Inflammatory Disease of Breast; Abscess (acute) (chronic) (nonpuerperal) of Breast, Areola; Mammillary Fistula; Mastitis (acute) (subacute) (nonpuerperal) NOS, Infective, Retromammary, Submammary |
| 675.1 - | Infections of the Breast and Nipple Associated with Childbirth, Abscess of Breast Associated with Childbirth; Mammary; Subareolar; Submammary |
| 681 - | Cellulitis and Abscess of Finger and Toe, Finger |
| 681.0 - | Cellulitis and Abscess of Finger |
| 681.00 - | Finger, Cellulitis and Abscess, Unspecified |
| 681.01 - | Finger, Felon; Pulp abscess; Whitlow |
| 681.1 - | Cellulitis and Abscess of Toe |
| 681.10 - | Toe, Cellulitis and Abscess, Unspecified |
| 681.9 - | Cellulitis and Abscess of Unspecified Digit; Infection of Nail NOS |
| 682 - | Other Cellulitis and Abscess; Abscess (Acute) (with Lymphangitis) except Finger or Toe; Cellulitis (Diffuse) (with Lymphangitis) except Finger or Toe |
| 682.0 - | Cellulitis and Abscess of Face; Cheek, External; Chin; Forehead; Nose, External; Submandibular; Temple (Region) |
| 682.1 - | Cellulitis or Abscess of Neck |
| 682.2 - | Cellulitis and Abscess of Trunk; Abdominal Wall; Back [Any Part, except Buttocks]; Breasts; Chest Wall; Flank; Groin; Pectoral Region; Perineum; Umbilicus |
| 682.3 - | Cellulitis and Abscess of Upper Arm and Forearm [Any Part, except hand], including Shoulder and Axilla |
| 682.4 - | Cellulitis and Abscess of Hand, except Fingers and Thumb; Wrist |
| 682.5 - | Cellulitis and Abscess of Buttock; Gluteal Region |
| 682.6 - | Cellulitis and Abscess of Leg, Except Foot; Ankle; Hip; Knee; Thigh |
| 682.7 - | Cellulitis and Abscess of Foot, Except Toes; Heel |
| 682.8 - | Cellulitis and Abscess, Other Specified Sites; Head [except Face]; Scalp |
| 682.9 - | Cellulitis and Abscess, Other Unspecified Sites |
| 685.0 - | Pilonidal Cyst; Fistula, Coccygeal or Pilonidal; Sinus, Coccygeal or Pilonidal, with Abscess |
| An abscess is a localized infection (usually bacterial) that has been walled off by a protective lining called a pyogenic membrane. The abscess is a defense mechanism designed to prevent the spread of the infectious organism to other parts of the body. The abscess contains pus made up of destroyed tissue cells, microorganisms (dead and alive), and white blood cells (leukocytes) that have been carried to the area to fight the infection. Whether the abscess enlarges or subsides depends on whether the microorganisms or the leukocytes gain the upper hand. Fungi or single-celled parasites called ameba can also cause abscesses.
Although an abscess may occur in any organ or tissue of the body, common sites include the breast (mammary abscess), gums (dental abscess), armpit, and groin. Less common sites include the liver, lung, gastrointestinal tract, kidney, spleen, pancreas, brain, and spinal cord. The infecting organism is usually transported through the bloodstream (hematogenous spread) to the affected organ. Abscesses are classified according to location, as is exemplified by the following: the abdominal cavity (intraperitoneal abscess), near the kidney or spine (retroperitoneal abscess), or within abdominal organs (visceral abscess).
Intra-abdominal abscesses most often form when gastrointestinal contents (including bacteria) are released into the abdominal cavity. Conditions such as appendicitis, diverticulitis, perforated peptic ulcers, and abdominal surgery can cause intra-abdominal abscesses. Brain abscesses often originate from an ear or sinus infection. Abscesses can also form under the skin from several different routes including external locations (from a wound or an infected hair root), a distant source through the bloodstream, or directly from an internal organ (lung or gastrointestinal system).
Individuals with cancer, diabetes, alcoholism, and those who use corticosteroids or have had abdominal surgery are at increased risk of developing intraperitoneal abscesses. Alcoholics, individuals with gallstones, and those who have recently undergone endoscopic retrograde cholangiopancreatography are at increased risk of developing pancreatic abscesses. Risk factors for developing a kidney abscess include kidney stones (calculi), diabetes mellitus, abnormalities of the urinary tract, and a history of surgery to the urinary tract. Risk factors for developing a lung abscess include gum disease, alcoholism, injection drug use, lung cancer, diabetes mellitus, and inhalation (aspiration) of stomach contents due to heartburn (gastroesophageal reflux). Individuals at risk for spinal epidural abscess include those with diabetes mellitus, alcoholism, kidney failure, and cancer; and those who have had a spinal tap (lumbar puncture), spinal anesthesia, or spinal surgery. Immunocompromised individuals are generally at an increased risk of developing abscesses.Risk: Injection drug users have an increased risk of developing skin and splenic abscesses; alcoholics are at increased risk for developing pancreatic, intraperitoneal, spinal epidural, and lung abscesses. Incidence and Prevalence: Superficial abscesses in the breast, mouth, and skin are common. Abscesses of internal organs are rare. Men suffer from brain abscesses twice as often as women (Ernoehazy). |
Source: Medical Disability Advisor
| History: Individuals with an abscess close to the skin (cutaneous or subcutaneous) may complain of heat, swelling, tenderness, redness over the affected site, and possibly fever. Internal abscesses produce local pain and tenderness, fever, chills, weight loss, fatigue, and loss of appetite. Intra-abdominal abscesses can also cause vomiting, diarrhea, or constipation. Symptoms of a lung abscess include a cough, foul-smelling material coughed up from the lungs, fever, chills, chest pain, weakness, fatigue, and a vague feeling of discomfort or illness (malaise). A spinal epidural abscess causes back pain, fever, and weakness. Brain abscess may cause headache, fever, speech disorder, muscle weakness, impaired vision, seizures, nausea, and vomiting. Some types of abscess are associated with alcoholism or intravenous drug abuse. Physical exam: Physical findings will depend on the location of the abscess. An intra-abdominal abscess may cause tenderness localized to a particular abdominal quadrant and a mass may be detected by touch (palpation). Lung abscess may cause crackling (rales), wheezing, abnormal breath sounds, and dullness to percussion. In some individuals, the presenting symptom is abnormal functioning of the organ in which the abscess has formed. Tests: Because most abscesses are caused by bacterial infection, material removed from the abscess and blood samples are cultured in the laboratory to identify the causative organism(s). Mucous material coughed up from the lungs (sputum) of individuals with a suspected lung abscess would be cultured. Cerebrospinal fluid may be cultured in individuals with suspected spinal epidural abscess. Antibiotic susceptibility tests may also be performed. Complete blood count (CBC), erythrocyte sedimentation rate (ESR), liver enzymes, and amebic serologic tests may be performed. If amebic abscess is suspected, stool samples will be analyzed for the presence of ameba. Tuberculin test (PPD test) may be performed on individuals with lung abscess.
The diagnosis may be confirmed by plain x-rays, ultrasound exams, CT scanning, or MRI imaging techniques. Radionuclide scanning, in which radioactively labeled white blood cells (or the element gallium) concentrate in the region where pus has recently formed, may also be used. |
Source: Medical Disability Advisor
| A minor abscess can sometimes heal without intervention; however drugs are usually necessary to combat the infection. Antibiotics are used for bacterial infections, antifungal drugs for fungal infections, and antiamebic drugs for amebic infections. Drainage is usually necessary either through an open surgical procedure or directly through the skin (percutaneous). Repair of a gastrointestinal defect may involve closure of a hole or removal of the appendix. Most spinal abscesses are treated with antibiotic therapy before neurological complications occur, making surgical drainage and removal of the lamina (laminectomy) unnecessary. |
Source: Medical Disability Advisor
| Early intervention and appropriate treatment of minor abscesses result in an effective cure. The outcome of a deep-seated abscess depends on the location of the abscess, the age of the individual, and the timing and effectiveness of treatment. An abscess within a vital organ (i.e., liver or brain) may occasionally cause enough pressure or damage to surrounding tissue that some permanent loss of function results. Percutaneous drainage of intra-abdominal abscess has up to a 90% success rate.
Surgical repair of a gastrointestinal defect (e.g., closure of a hole) usually has a good outcome. A ruptured intra-abdominal abscess, however, has a high mortality rate. Pancreatic abscesses have a 100% mortality rate if surgical drainage is not performed. Although brain abscess has only a 10% mortality rate, 30% to 55% of these survivors suffer from nervous system complications (sequelae). In spinal abscess, laminectomy and drainage can prevent, reverse, or improve developing paralysis; however, they will probably not improve established nervous system deficits. |
Source: Medical Disability Advisor
| Bacterial infection of the blood (sepsis) may spread the infection to other body sites. Other complications include rupture into adjacent tissue, bleeding from vessels eroded by inflammation, and impaired function of a vital organ. Spinal abscess can cause paralysis. Brain abscess can cause nervous system defects. |
Source: Medical Disability Advisor
| Work restrictions and accommodations require individual consideration. Abscess in an internal organ (e.g., liver, lung, gastrointestinal tract, kidney, spleen, pancreas, brain, or spinal cord) may require a temporary limit on heavy lifting or activities that involve physical exertion. Temporary reassignment to sedentary duties may be necessary.
An armpit or groin abscess may temporarily limit the use of the affected limb. An individual with a complicated brain or spinal epidural abscess may require more extensive accommodations or restrictions depending on the severity of the nervous system deficits. An individual with a complicated spinal epidural abscess, for example, may be confined to a wheelchair and so requires wheelchair accessibility in the workplace. An individual with speech impairment because of a complicated brain abscess may need reasonable accommodations or reassignment. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Where was the abscess located? Was a vital organ involved?
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Did physical findings confirm individual's report?
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Were there nonspecific symptoms such as weight loss, fatigue, or loss of appetite?
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Did a blood test confirm an abnormally large number of white blood cells indicative of infection?
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Were x-rays, ultrasound scanning, CT, or MRI used to determine size and position of abscess?
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Was microscopic examination done to identify causative organism?
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Do culture results confirm diagnosis?
Regarding treatment:
- Was surgical drainage necessary?
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Was laboratory analysis of pus used to select the most effective antibiotic, antifungal, or antiamebic drug?
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Is there evidence of response to treatment?
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Is there a possibility of antibiotic-resistant bacteria?
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Is change of antibiotic warranted?
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Has individual recently used any alternative medication or health practices?
Regarding prognosis:
- What is the overall health of individual?
|
Source: Medical Disability Advisor
| Ernoehazy, William. "Brain Abscess." eMedicine. Eds. Edward Bessman, et al. 10 Aug. 2004. Medscape. 17 Dec. 2004 <http://emedicine.com/EMERG/topic67.htm>. |
Source: Medical Disability Advisor
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