Review

Lung abscess

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 Definitions
• Lung abscess is defined as a
circumscribed area of pus or necrosis in
the pulmonary parenchyma caused by
microbial infection.

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 Definitions
• Primary lung abscesses
– result from direct infection
– Most result from aspiration of oral or
gastric contents.
• Secondary lung abscesses
– predisposing condition such as bronchial
obstruction (eg, foreign body, neoplasm),
hematogenous spread (eg, right-sided
endocarditis), thoracic surgery, or impaired
host defenses.
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 Pathogenesis
• Aspiration
• Hematogenous spread 
• Direct extension 
• Bronchial obstruction
• Superinfection or spread of airway
infection

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 Microbiology
• Aspiration
– typically polymicrobial, reflecting oral and
gingival flora.
– most commonly isolated pathogens are
microaerophilic Streptococci and
anaerobes
– Anaerobes
include Peptostreptococcus, Prevotella, Bacter
oides (usually not B. fragilis),
and Fusobacterium
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 Microbiology
• Pneumonia caused by pyogenic bacteria
– Aerobic bacteria
• Staphylococcus aureus (with influenza)
• Klebsiella pneumoniae (with structural lung
disease)
• Pseudomonas aeruginosa
• Streptococcus pyogenes
• Burkholderia pseudomallei
• Haemophilus influenzae type b,
• Legionella
• Nocardia
• Actinomyces 6
 Microbiology
• Nonbacterial pathogens
– Fungus
– TB
– NTM
– parasites

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Microbiology

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 Clinical features
• nonspecific and mimic pneumonia
• the identification of one or more
cavities filled with fluid or with an air-
fluid interface on chest imaging that
raises the suspicion for lung abscess.

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 Clinical features
• Symptoms and signs
– fever and chills (80 percent),
– productive cough (often putrid, sour-
tasting; 55 to 90 percent),
– dyspnea (10 percent),
– chest pain when the pleural space is
involved (20 to 35 percent
– hemoptysis (10 percent) 

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 Clinical features
• Chest radiograph
– manifest as a fluid-filled space, typically
with an air-fluid interface, within an area of
consolidation, mass, or nodule

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 Clinical features
• Chest radiograph
– manifest as a fluid-filled space, typically
with an air-fluid interface, within an area of
consolidation, mass, or nodule

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 Clinical assessment
• Microbiologic testing
– two sets of blood cultures for both aerobic
and anaerobic culture
– Sputum Gram stain and culture
– For patients who do not expectorate
sputum, bronchoscopic sampling and/or
percutaneous needle aspiration or (rarely)
biopsy may be indicated
– Despite obtaining respiratory cultures, up
to 50 percent of patients do not have a
positive culture 13
 Clinical assessment
• Chest computed tomography
– an area of cavitation surrounded by
consolidation.
– The necrotic region tends to be irregular in
shape.
– The wall of an acute abscess is often thick
– the cavity wall typically becomes thin and
uniform as the abscess heals
– Air fluid levels within the abscess are
common
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 Clinical assessment
• Chest computed tomography
– distinguish between a parenchymal lesion
and a pleural collection (eg,
parapneumonic effusion or empyema)
– Abscesses tend to be more irregular in
shape, spherical, and cavitated
– empyemas tend to be better defined,
elliptical, homogeneous, and have a
smooth and uniform wall.
– Empyema may displace the blood vessels
leading from the hilum to the periphery 15
Treatment

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Treatment

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Treatment

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Treatment

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Treatment

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Treatment

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