Lung Abscess

Definition

Is necrosis of the pulmonary parenchyma caused by microbial infection

Is generally caused by aspiration of anaerobic bacteria

Chest x-ray demonstrates a cavity of at least 2 cm

Persons at risk: those with impaired cough reflexes and those with swallowing difficulties; those with CNS disorders; drug addiction, alcoholism, esophageal disease, or compromised immune function; patients without teeth and those receiving NGT feeding; and patients with an altered state of consciousness due to anesthesia

Pathophysiology

A complication of pneumonia / aspiration of oral anaerobes into the lungs; PTB, chest trauma, pulmonary embolism, bronchial stenosis and obstruction of the bronchi by a tumor
Formation of abscess by the immune system components

The abscess becomes surrounded, or encapsulated, by a wall of fibrous tissue

Necrotic tissue may extend to bronchus / to pleura or both. (if bronchus is involved purulent sputum is expected; if pleura is involved empyema results) Connection between pleura and bronchus bronchopleural fistula

Manifestations

Mild productive cough

Fever

Dull chest pain (pleurisy)

Dyspnea Weakness Anorexia Weight loss

Copious amount of foul-smelling, sometimes bloody sputum Leukocytosis