Lung Abscess

Dr. Ravi Gadani

MS, FMAS
Introduction
• Necrosis of lung tissue due to localized area of lung infection
• Due to thrombosis of segmental artery or vein due to infection
• Usually secondary to pneumonia with certain bacterial species noted
for causing necrotizing ability-post pneumonic abscess
 Aspiration of gastric Located in posterior
Causes contents- most common
lobes
Septic emboli

Foreign material due to

penetrating injury

Chronic URTI- dental

infection, tonsillitis

Partial or complete
obstruction due to growth
Causative organism
• Staphylococcus
• Streptococcus
• Pneumoccocus
• Haemophilus influenza
• Coliform organism
• Anaerobic infection due dental infection
Pathology – Early
This segment
Inhalation or
Material obstructs further invaded by
aspiration of Atelectasis
small bronchi bacteria-
infected
suppuration begins

Pus –tension—
Tissue necrosis— Thrombosis of
rupture of abscess Involves the vessels
lung abscess vessel
into bronchi

Expectoration of Infection may

pus subside
Pathology – Late

Zone of
inflammatory
State of chronic Spread to adjacent
consolidation Chronic stage
infection persists part of normal lung
surrounds the
abscess cavity
Symptoms
• Symptoms depend on whether the abscess is caused by anaerobic or
other bacterial infection.
• 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.
• The expectorated sputum characteristically is foul smelling and bad tasting.
• Patients may develop hemoptysis or pleurisy
Symptoms
• Other pathogens in lung abscess
• These patients generally present with conditions that are more emergent in
nature and are usually treated while they have bacterial pneumonia.
• Cavitation occurs subsequently as parenchymal necrosis ensues.
• Abscesses from fungi, Nocardia species, and Mycobacteria species tend to
have an indolent course and gradually progressive symptoms.
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 gingival
disease.
• Clinical findings of concomitant consolidation may be present (eg,
decreased breath sounds, dullness to percussion, bronchial breath
sounds, coarse inspiratory crackles).
Examination
• 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.
Examination
Investigations
• Blood examination
• Sputum examination
• Chest Xray-
• Lesion with air fluid level
• Other conditions-
• Hydatid cyst
• Cavitated epidermoid carcinoma
• Tuberculous cavity
• Pulmonary mycosis
Investigations
Investigations
• Bronchoscopy-
• Exclude neoplasm and foreign body
Treatment
• Medical
• 80 -90% lung abscess treated with medicines
• Intensive antibiotic therapy
• Selection of antibiotic- C/S
• Double dose of antibiotics
• 3week treatment
• Staphyloccocuc may require 6week rx
Medical treatment
• Postural drainage
• 2hrs three times daily
• Bronchoscopy for aspiration of the pus repeatedly
• Repeat CXR, extensive chest physiotherapy required
Surgical treatment
• Failure of medical therapy
• Suspected or associated carcinoma of lungs
• Surgical options
• Pneumotomy or drainage of abscess
• Pulmonary resection
Pneumotomy
• Drainage of abscess through the chest wall by subperiosteal resection
of portion of rib over the abscess
• Elderly debilitated pts who cant withstand lobectomy
• Healing of track can take months to heal
• Less commonly done due to use of antibiotics
Pulmonary resection
• Lobectomy done as it is replaced by a cavity
• Care to be taken to avoid abscess spillage to adjacent lobe