Lung Abscess
Sung Chul Hwang, M.D.
Dept. of Pulmonary and Critical Care Medicine
Ajou University School of Medicine
Definition
 Infection of the lung parenchyme
consisting of one or more necrotic
inflammatory cavities, containing
fibropurulent exudates and gaseous
materials
Etiology of Lung Abscess
 Aspiration : seizure, coma, surgery, DM,




sedatives, alcohol, neurologic diseases
Bronchial obstruction : malignancy, F.B.
Septic emboli : SBE, catheters, prostheses,
pelvic thrombophlebitis
Direct Spread : subphrenic, hepatic
Pneumonia complication : S. aureus,
Klebsiella, pseudomonas, etc
Classifications
 Duration
 Causes
 Acute < 4-6 week
 Primary
 Chronic
 Secondary
Symptoms of Lung Abscess
 Cough : 77%
 Sputum : 65%
 Fever and chills : 40%
 Chest pain : 24%
 Hemoptysis : 16%
 Dyspnea : 15%
 Anorexia : 4%
 Night sweats : 1 %
Aspiration Abscess
 Most common cause
 Tosillectomy, seizure, neurosurgery, alcoholism, etc
 Organism identification in only 30-40%
 Mostly Anarobic, mixed organisms
 “Putrid sputa”
 Dependent portions: Lowerlobe,posteior & lateral
basal seg. Upper lobe, posterior seg.
 Usually single abscess cavity
Necrotizing Pneumonia
 Community :Staph. Aureus or Klebsiella
 Hospital : Pseudomonas or Proteus
 Aspiration pneumonias cause necrotizing
infections
 Klebsiella predominant in alcoholics or DM
Secondary to Malignancy
 Bronchogenic cancer : Squamous Ca
 Lymphoma
 Leukemia
 Multiple Myeloma
 Metastatic Malignancies
Diagnosis
 X-ray : Cavity with “air-fluid level”
 CBC : leukocytosis, Anemia , etc
 Cultures : Sputum & Blood
 Anaerobic culture is important
 Chest CT
 Sputum cytology
 Sputum AFB
 Bronchoscopy or NAB to Rule out malignancy
Treatment
 Medical treatment is the mainstay
 Pennicillin, Cephalosporin
 Clindamycin, chloramphenicol,
Metronidazole to cover for the
Anarobes
 Postural drainage
 Bronchoscopic drainage
Indications for Surgery
 Massive hemoptysis
 Refractory to Medical treatment
 Large cavity with thick walls
 Complicated by malignancy
 Empyema develops
 Chronicity, Recurrence
 Remaining residual cavity
Prognosis
 Relatively Favorable
 Underlying Disease is important
 Operation Rate : 15%
 Overall mortality rate : 10%
Empyema
 Mainly Surgical disease
 Presence of Pus or demonstrable Micro-
organisms such as, Bacteria,
mycobacterium, or fungus in pleural cavity
 Closed Drainage
 Pig-tail catheter insertion with intra-pleural
urokinase instillation
 Surgical drainage with empymectomy :
conventional surgery or VATS
Lung Abscess
Cavity with
“Air-Fluid level”
Lung Abscess
Left Upper Lobe Posterior Segment
Lung Abscess
Pseudomonas Lung Abscess
Lung Abscess
Malignant Abcess Cavity
Septic Pneumonia
mMultiple Bilateral Septic Emboli
u
Septic Emboli
Septic Emboli in Pulmonary arteries : H & E
Empyema
Empyema
Empyema
pus
diaphragm
Indication for Pneumococcal
Vaccination (Polyvalent)
 >65 years
 Chronic Cardiac conditions
 Chronic Lung Diseases
 Asplenia
 Chronic Liver Diseases
 Alcoholism
 DM
 Chronic Renal Failure
 Hodgkin’s Disease
 Leukemia, Multiple myeloma
 Chronic hemodialysis
 HIV Infection