Lung abscess

Lung abscess is defined as necrosis of the

pulmonary tissue and formation of cavities
containing necrotic debris or fluid caused by
microbial infection. The formation of multiple small
(<2 cm) abscesses is occasionally referred to as
necrotizing pneumonia or lung gangrene. Both lung
abscess and necrotizing pneumonia are
manifestations of a similar pathologic process.
Failure to recognize and treat lung abscess is
associated with poor clinical outcome.
Division of lung abscesses
 Epidemiology
Lung abscesses likely occur more commonly in
elderly patients because of the increased
incidence of periodontal disease and the
increased prevalence of dysphagia and
aspiration. However, a case series from an urban
center with high prevalence of alcoholism
reported a mean age of 41 years.
 Pathophysiology
Most frequently, the lung abscess arises as a
complication of aspiration pneumonia caused by
mouth anaerobes. The patients who develop lung
abscess are predisposed to aspiration and
commonly have periodontal disease. A bacterial
inoculum from the gingival crevice reaches the
lower airways and infection is initiated because the
bacteria are not cleared by the patient's host
defense mechanism. This results in aspiration
pneumonitis and progression to tissue necrosis 7-14
days later, resulting in formation of lung abscess
 Risk actor
• Periodontal disease
• Seizure disorder
• Alcohol abuse
• Dysphagia
 Causes
Infrequently, the following infectious etiologies of pneumonia
may progress to parenchymal necrosis and lung abscess
formation:
• Pseudomonas aeruginosa
• K pneumoniae
• S aureus (may result in multiple abscesses)
• Streptococcus pneumoniae
• Nocardia species
• Actinomyces species
• Fungal species
• An abscess may develop as an infectious complication of a
preexisting bulla or lung cyst.
 Signs and symptoms
a.Anaerobic infection in lung abscess
Patients often present with indolent symptoms that
evolve over a period of weeks to months. The usual
symptoms are fever, cough with sputum
production, night sweats, anorexia, and weight loss.
b. Other pathogens in lung abscess
These patients generally present with conditions
that are more acute in nature and are usually
treated while they have bacterial pneumonia
 Physical Examination
Patients with lung abscesses may have low-grade fever in anaerobic
infections and temperatures higher than 38.5°C in other infections.
Generally, patients with in lung abscess have evidence of gingivitis
and/or periodontal disease.
• Clinical findings of concomitant consolidation may be present (eg,
decreased breath sounds, dullness to percussion, bronchial breath
sounds, coarse inspiratory crackles).
• The amphoric or cavernous breath sounds are only rarely elicited in
modern practice. Evidence of pleural friction rub and signs of
associated pleural effusion, empyema, and pyopneumothorax may
be present. Signs include dullness to percussion, contralateral shift
of the mediastinum, and absent breath sounds over the effusion.
• Digital clubbing may develop rapidly.
 Reeeral Examination
• Chest radiography
• Computed tomography
 Differential diagnosis
• Excavating bronchial carcinoma (squamocellular
or microcellular);
• Excavating tuberculosis;
• Localized pleural empyema;
• Infected emphysematous bullae;
• Cavitary pneumoconiosis;
• Hiatus hernia;
• Pulmonary hematoma;
• Hydatid cyst of lung;
• Cavitary infarcts of lung
 Complications
Complications of pulmonary abscess include the
following:
• Rupture into pleural space causing empyema
• Pleural fibrosis
• Trapped lung
• Respiratory failure
• Bronchopleural fistula
• Pleural cutaneous fistula
 Therapy

Antibiotic Therapy
• clindamycin
• metronidazole
• vancomycin and linezolid
• Ampicillin plus sulbactam
• Moxifloxacin
Surgical Care
 prognosis
• The prognosis for lung abscess following
antibiotic treatment is generally favorable.
Over 90% of lung abscesses are cured with
medical management alone, unless caused by
bronchial obstruction secondary to carcinoma
 Prevention
Prevention of aspiration is important to minimize
the risk of lung abscess. Early intubation in patients
who have diminished ability to protect the airway
from massive aspiration (cough, gag reflexes),
should be considered.
Positioning the supine patient at a 30° reclined
angle minimizes the risk of aspiration. Vomiting
patients should be placed on their sides.Improving
oral hygiene and dental care in elderly and
debilitated patients may decrease the risk of
anaerobic lung abscess.
 Conclusion
Lung abscess is defined as necrosis of the pulmonary
tissue and formation of cavities containing necrotic debris
or fluid caused by microbial infection
A lung abscess may be asymptomatic in a small
proportion of patients in the early stages.
The findings on physical examination of a patient with
lung abscess are variable.Patients with lung abscesses
may have low-grade fever in anaerobic infections and
temperatures higher than 38.5°C in other infections.
Generally, patients with in lung abscess have evidence of
gingivitis and/or periodontal disease