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Computed tomography (CT) scan of chest showing bilateral

pneumonia with abscesses, effusions, and caverns. 37 year
old male.

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 is necrosis of the pulmonary tissue and formation of cavities (more than 2 cm)[1]
containing necrotic debris or fluid caused by microbial infection.

This pus-filled cavity is often caused by aspiration, which may occur during altered
consciousness. Alcoholism is the most common condition predisposing to lung abscesses.

Lung abscess is considered  (60%[2]) when it results from existing lung parenchymal
process and is termed 

 when it complicates another process e.g. vascular emboli or
follows rupture of extrapulmonary abscess into lung.




[hide]

à| 1 Causes
à| 2 Signs and symptoms
à| 3 Diagnosis
à| ‰ Management
à| 5 Complications
à| 6 Prognosis
à| 7 See also
à| 8 References


  
Conditions contributing to lung abscess

à| Aspiration of oropharyngeal or gastric secretion

à| Septic emboli
à| Îecrotizing pneumonia
à| åasculitis: Wegener's granulomatosis
à| Îecrotizing tumors: 8% to 18% are due to neoplasms across all age groups, higher in
older people; primary squamous carcinoma of the lung is the commonest.

Organisms

In the post-antibiotic era pattern of frequency is changing. In older studies anaerobes were found
in up to 90% cases but they are much less frequent now[3].

à| Anaerobic bacteria: Peptostreptococcus, Bacteroides, Fusobacterium species,

à| Microaerophilic streptococcus : è    
à| Aerobic bacteria: Staphylococcus, Klebsiella, Haemophilus, Pseudomonas, Îocardia,
Escherichia coli, Streptococcus, Mycobacteria[‰]
à| Fungi: Candida, Aspergillus
 à| Parasites: Entamoeba histolytica,





 
Onset of symptoms is often gradual, but in necrotizing staphylococcal or gram-negative bacillary
pneumonias patients can be acutely ill. Cough, fever with shivering and night sweats are often
present. Cough can be productive with foul smelling purulent sputum (§70%) or less frequently
with blood (i.e. hemoptysis in one third cases) [5]. Affected individuals may also complain of
chest pain, shortness of breath, lethargy and other features of chronic illness.

Patients are generally cachectic at presentation. Finger clubbing is present in one third of
patients[5]. Dental decay is common especially in alcoholics and children. On examination of
chest there will be features of consolidation such as localised dullness on percussion, bronchial
breath sound etc.






Pathology image of a lung abscess.

Chest Xray and other imaging studies

Abscess is often unilateral and single involving posterior segments of the upper lobes and the
apical segments of the lower lobes as these areas are gravity dependent when lying down.
Presence of air-fluid levels implies rupture into the bronchial tree or rarely growth of gas
forming organism.

Laboratory studies

Raised inflammatory markers (high ESR, CRP) are usual but not specific. Examination of
sputum is important in any pulmonary infections and here often reveals mixed flora.
Transtracheal of Transbronchial (via bronchoscopy) aspirates can also be cultured. Fibre optic
bronchoscopy is often performed to exclude obstructive lesion; it also helps in bronchial
drainage of pus.


 


Broadspectrum antibiotic to cover mixed flora is the mainstay of treatment. Pulmonary
physiotherapy and postural drainage are also important. Surgical procedures are required in
selective patients for drainage or pulmonary resection.


  

Rare nowadays but include spread of infection to other lung segments, bronchiectasis, empyema,
and bacteraemia with metastatic infection such as brain abscess[2].




Most cases respond to antibiotic and prognosis is usually excellent unless there is a debilitating
underlying condition. Mortality from lung abscess alone is around 5% and is improving.



à| Other chronic lung infections
m| Empyema
m| Bronchiectasis
à| Abscess
à| Pleural effusion




1.| V Bartlett JG, Finegold SM (1972). "Anaerobic pleuropulmonary infections". £


  G (6): ‰13±50. PMID ‰56‰‰16.
2.| V c "Pneumonia and Other Pulmonary Infections: Lung Abscess, Medscape". Archived
from the original on 2007-10-11.
http://web.archive.org/web/20071011102817/http://www.medscape.com/viewarticle/53‰
860. Retrieved 2007-06-20.
3.| V Bartlett JG (2005). "The role of anaerobic bacteria in lung abscess". î   
‰ (7): 923±5. doi:10.1086/‰28586. PMID 1582‰980.
‰.| V Hirshberg B, Sklair-Levi M, Îir-Paz R, Ben-Sira L, Krivoruk å, Kramer MR (1999).
"Factors predicting mortality of patients with lung abscess.". î G (3): 7‰6±50.
doi:10.1378/chest.115.3.7‰6. PMID 1008‰‰87.
5.| V c Moreira Jda S, Camargo Jde J, Felicetti JC, Goldenfun PR, Moreira AL, Porto Îda S
(2006). "Lung abscess: analysis of 252 consecutive cases diagnosed between 1968 and
200‰". ’ 

  
  
  

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