This document discusses pulmonary abscesses in children. It defines a lung abscess as a localized collection of thick-walled purulent material within the lung parenchyma caused by infection and tissue destruction. Lung abscesses can be primary, occurring in previously healthy patients, or secondary, occurring in patients with underlying conditions. Common predisposing factors include aspiration, pneumonia, cystic fibrosis, and immunosuppression. Symptoms include cough, fever, dyspnea, and chest pain. Diagnosis involves chest X-ray and CT scan identifying a cavity containing air-fluid levels. Treatment consists of antibiotics for 2-3 weeks, with surgical drainage for severe or unimproving cases. Prognosis is generally excellent.

1. Pulmonary Abscess in Children
Dr.Padmesh. V

2. Lung infection
Destroys lung parenchyma
Cavitations and central necrosis
Localized areas of thick-walled purulent material
Lung abscess

3. • Primary lung abscess:
• Occur in previously healthy patients with no
underlying medical disorders.
• Usually solitary.
• Secondary lung abscess:
• Occur in patients with underlying or predisposing
conditions
• May be multiple.

4. • PATHOLOGY AND PATHOGENESIS
• Predisposing conditions:
• Aspiration (of infected material or FB)
• Pneumonia / Hematogenous seeding from other sites
• Cystic fibrosis
• Gastroesophageal reflux
• Tracheoesophageal fistula
• Immunodeficiencies
• Postoperative complications of tonsillectomy and
adenoidectomy
• Seizures
• Neurologic and other conditions associated with
impaired mucociliary defense.

5. • PATHOLOGY AND PATHOGENESIS:
Aspiration of infected material or foreign body
Pneumonitis impairs drainage of fluid or aspirated
material
Inflammatory vascular obstruction
Tissue necrosis, liquefaction
Abscess formation

6. • PATHOLOGY AND PATHOGENESIS
Aspiration in recumbent position
Right & Left upper lobes and apical segment of the
right lower lobes most likely.
Aspiration in upright position
Posterior segments of upper lobes most likely

7. • PATHOLOGY AND PATHOGENESIS
• Primary abscesses: Most often on Right side.
• Secondary lung abscesses, esp in
immunocompromised : Predilection for left side.

8. • Organisms: Both anaerobic and aerobic organisms.
• Anaerobic bacteria:
• Bacteroides spp.,
• Fusobacterium spp.,
• Peptostreptococcus spp.,
• Aerobic bacteria:
• Streptococcus spp.,
• Staphylococcus aureus
• Escherichia coli
• Klebsiella pneumoniae
• Pseudomonas aeruginosa
• Mycoplasma pneumoniae (Very rare)
• Fungi can cause lung abscess,esp in immunocompromised.

9. • CLINICAL MANIFESTATIONS: Symptoms
• Cough,
• Fever,
• Dyspnea,
• Chest pain,
• Vomiting,
• Sputum production,
• Weight loss,
• Hemoptysis.

10. • CLINICAL MANIFESTATIONS: Signs
• Tachypnea
• Dyspnea
• Retractions with accessory muscle use
• Decreased breath sounds
• Dullness to percussion in affected area
• Crackles
• Occasionally a prolonged expiratory phase on
auscultation

11. • Diagnosis:
• Chest X Ray: Parenchymal inflammation with a
cavity containing an air–fluid level .

12. • Diagnosis:
• Chest CT scan:
Abscess is usually a thick-walled lesion with a
low-density center progressing to an air–fluid level.

13. • Diagnosis:
• Gram stain of sputum: Early clue.
• Sputum cultures: Yield mixed bacteria, therefore
not always reliable.
• Attempts to avoid contamination from oral flora include direct lung
puncture, percutaneous (aided by CT guidance) or transtracheal
aspiration, and bronchoalveolar lavage specimens obtained
bronchoscopically.

14. • Diagnosis:
• Bronchoscopic aspiration should be avoided as it
can be complicated by massive intrabronchial
aspiration.
• To avoid invasive procedures in previously normal
hosts, empiric therapy can be initiated in the
absence of culturable material.

15. • Differential Diagnosis:
• Abscesses should be distinguished from pneumatoceles.
• Pneumatoceles often complicate severe bacterial
pneumonias.
• Pneumatoceles: Thin- and Smooth-walled, localized air
collections with or without air–fluid level.
• Pneumatoceles often resolve spontaneously with
treatment of specific cause of the pneumonia.

16. • TREATMENT:
• Conservative management.
• 2-3 wk course of parenteral antibiotics for
uncomplicated cases, followed by oral antibiotics to
complete a Total of 4-6 wk.
• Aerobic and anaerobic coverage.
• Include penicillinase-resistant agent active against S.aureus
and anaerobic coverage, typically clindamycin or
ticarcillin/clavulanic acid.
• If Gram-negative bacteria are suspected or isolated, an
aminoglycoside should be added.

17. • TREATMENT
• Early CT-guided percutaneous aspiration or drainage.
• Severely ill or those who fail to improve after 7-10 days of
antibiotics  Surgical intervention.
• Minimally invasive CT guided percutaneous aspiration.
• Thorascopic drainage.
• In rare complicated cases  Thoracotomy with surgical
drainage or lobectomy and/or decortication.

18. • PROGNOSIS
• Excellent.
• Presence of aerobic organisms may be a negative
prognostic indicator, particularly in those with
secondary lung abscesses.
• Most become asymptomatic within 7-10 days,
although fever can persist for as long as 3 wk.
• Radiologic abnormalities usually resolve in 1-3 mo
but can persist for years.

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