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• Circumscribed cavity within the lung

parenchyma filled with purulent
material and air

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• Primary lung abscess
• Aspiration of oropharyngeal secretions

• Altered consciousness

• Esophageal diseases

• Oral cavity disease

• Necrotizing pneumonia

• Immunosuppression

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• Secondary lung abscess
• Associated with other pathologies
• Direct extension

• Hematogenous spread

• Bronchial obstruction

• Cavitary lesions

• Complication of pulmonary trauma

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• Acute Vs. chronic

• Single Vs. Multifocal

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• Bacteriology depends on the underlying cause
• mostly aspiration induced

• Multibacterial( the same as pneumonia etiologically even

through polymicrobial
• S. aureus, S. pyogens, K. pneumoniae, P. aerugenosa

• Anaerobes

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• Commonly involves the dependent lung segments
• Posterior segment of the right upper lobe and superior
segment of both lobes
• RLL>RUL>LLL>LUL>RML

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• An extensive area of necrosis

• Multiloculated or uniloculated space filled with exudates, blood

and necrotic lung tissue
• The abscess usually communicates with bronchus

• Liquefied necrotic material empties through the draining

bronchus - Necrotic cavity containing air-fluid level

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• Cough productive of copious putrid sputum

• Pluritic chest pain

• Hemptysis

• Dyspnea

• High grade intermittent fever, Malaise, weight loss

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• Septic shock

• Massive hemoptysis

• Pyopneumothorax

• Empyma necessitants

• Spill over to the contralateral lung

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•WBC count

•Sputum examination

• Gram stain and culture/sensitivity

•CXR – PA and Lateral

• Primary tool of investigation

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• CT scan of the lungs
• To differentiate it from other pathologies
• Clearly see the location of the abscess

• Bronchoscopy
• For drainage and collection of specimen for analysis
• Is not without risk

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• Medical
• Prolonged antibiotics
• Adequate drainage
• Internally
• Percutaneous
• Serial CXR

• Surgery
• Empyma
• BPF(bronchopleural fistula)
• Significant hemoptysis
• Persistence of the abscess
• ?Size >6 cm
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