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1. Lung abscess
DR. SINA AL-NOMI
Assist. prof. faculty of medicine
Taiz university
2021

2. Lung abscess
• Is a localized area of destruction of lung parenchyma
cause by infection of pyogenic organisms results in tissue
necrosis and suppuration.
• It manifests radiological as a cavity with an air-fluid
levels.
• 75% of abscess occur in posterior segment of the Rt. upper
lobe or Apical segments of either lower lobe.

3. Classification
 May be primary or secondary
 Primary : abscess in previously healthy patient or
in a patient at risk for aspiration
 Secondary : associated bronchogenic neoplasm or
immunocompromised patient

4. Risk factors / causes
 Infectious agent generally cause lung abscess:
1) Gram negative organisms as klebsiella, S. aureus, & anaerobic
bacilli.
2) T.B
3) Parasitic
4) Fungal disease of the lung as Histoplasma capsulatum, Aspergillus,
Candida
 Actinomyces israeli –single large lung abscess:
Lung infiltrate with honey comb of small abscess cavities that may
communicate with chest wall with bony destruction and sinus
formation
 HIV infection

5. Risk factors / causes
1) Most lung abscess are caused by aspiration of material from the GI tract in to
the lungs
Risk factors for aspiration include:
 Alcoholism
 Seizure
 Strock-Depressed conscious level
 Neuromuscular disorders
 Drug overdose, Sedation
 General anasthesia, Impaired laryngeal closure ( cuffed endotracheal tube),
tracheostomy tube, recurrent laryngeal nerve palsy )
 Disturbances of swallowing, Delayed gastric emptying

6. Risk factors / causes
2) Pre existing lung disease:
 Necrotizing pneumonia
 Bronchiectasis
 Cystic fibrosis
 Bronchial obstruction as in tumour, foreign body,
 congenital abnormalitis
 Infected pulmonary infarct
 Trauma
 Immunodeficiency

7. Risk factors / causes
3) Poor oral health: gum disease are more likely to get an
abscess, Dental / periodontal sepsis
4) Paranasal sinus infection
5) Poor immune system : like fungi or the bacteria that
cause T.B , Strep throat, & MRSA.

8. Risk factors / causes
6) Blood-borne causes: It’s rare, but bacteria or infected blood clot can travel
through bloodstream to the lung, where they cause an abscess.
 Hematogenous spread from a distal site:
1. UTI
2. Abdominal sepsis
3. Pelvic sepsis
4. Infective endocarditis
5. IV drug abuse
6. Infective IV canulae
7. Septic thrombophlebitis

9. Clinical manifestation
 Symptoms of a lung abscess commonly come slowly over weeks
to months. They may include:
 Cough with purulent sputum
(Sputum is a mixture of saliva & mucous with pus that’s often sour-tasting, foul
smelling, or streaked with blood)
 Haemoptysis
 Fever, Chills & night sweats
 Fatigue & loss of appetite
 Pleuritic chest pain
 Dyspnoea
 Weight loss

10. Clinical manifestation
 On examination: No signs specific for lung abscess
 Digital clubbing – develop within a few weeks if treatment is
inadequate
 Dullness on percussion
 Decrease breath sound on auscultation over the segment of lung
involved
 Crackles

11. Diagnosis
 History and physical examination
 Sputum, pleural fluid and blood culture
 AFB sputum smears  3
 Bronchoscopy to get samples of sputum or lung tissue
 Chest X-Ray
 CT Scan

12. Chest X- Ray

13. CT SCAN

14. DIFFERENTIAL DIAGNOSIS
 Cavitating lung cancer
 Localized Empyema
 Infected bulla containing a fluid level
 Pulmonary haematoma
 Hiatus hernia
 Hydatid cyst
 Infection with Paragonimus westermani
 Cavitating pulmonary infarcts
 Wegeners granulomatosis

15. Complications
 Chronic abscess: if it longer more than 6 weeks.
 Empyema: This is when an abscess breaks into the space
between lungs and chest wall and fills the space with pus.
 Bronchopleural fistula
 Pneumothorax , pyoneumothorax
 sepsis
 Metastatic cerebral abscess
 Fibrosis, bronchiectasis, amyloidosis
 Bleeding: It’s rare, but sometimes an abscess can destroy
a blood vessel and cause serious bleeding.

16. Management
 Medical management :
 Rest , good nutrition and adequate fluid intake are supportive
measures to facilitate recovery
 Antibiotics
used in large doses, for sufficient time,parentral, broad spectrum for
aerobes and anaerobes ( gm +ve & gm –ve, cocci & bacilli ), and
shift to oral antibiotics after that.
 Antibiotics given for prolonged period 4-6 weeks until a chest X-ray
shows the abscess is gone
 Penicillin is a drug of choice
 Clindamycin has been shown to be superior to penicillin and is the
standard treatment for anaerobic lung infection

17. Management
 Drainage: if the abscess is 6 centimeters or more in
diameter.
 Chest physiotherapy and postural drainage are helpful in
disease process.
 Bronchoscopy, for drainage (tamponade, or removal of
FB ).
 Transthoracic needle aspiration ( with toilet and local
antibiotic injection ).
 Intercostal tube drainage

18. Management
 Surgery:
 It’s rare, but some people need surgery to remove the part of the lung
with the abscess.
 Surgery is indicated in poor response to antibiotic therapy
 Large abscess > 6cm in diameter
 Resistance organisms as P. aeruginosa
 Massive or recurrent life threatening haemoptysis.
 Complicating Empyema.
 Suspicion of lung cancer.
 Surgery can also help to remove a foreign object
 The usual procedures is lobectomy or pneumonectomy