Lung abscess: pathogenesis, diagnosis and treatment.

Harvard Medical School, Boston, Massachusetts, USA.
Current clinical topics in infectious diseases 02/1998; 18:252-73.
Source: PubMed
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    ABSTRACT: A 57-year-old man was hospitalized and treated for community acquired pneumonia. He was found to have radiologic evidence of a lung abscess upon completion of his oral antibiotics. Complete resolution of the abscess in a 3-month-period without any medical or surgical intervention was confirmed thereafter by re-peated imaging study. Spontaneous resolution of lung abscess is possible and might be the fate of all uncomplicated lung abscesses if drainage into the tracheobronchial tree takes place early in the course. Host factors may play a role in predicting prognosis and treatment outcome. A 57-year-old man was admitted to the hospital for wors-ening shortness of breath for 3 days that was associated with fever, rigors, and night sweats for 2 days. He also complained of left-sided pleuritic chest pain aggravated by cough productive of white sputum. His past medical history was significant for psoriasis and a 40 pack-year of tobacco use. Medications included Naprosyn and a topical steroid cream. He had no history of tuberculosis, unusual exposures, or recent travel. On physical examination, the patient was well built and well nourished and appeared in moderate respiratory distress. His blood pressure was 165/90 mm Hg, heart rate 153 beats/min, respiratory rate 32 breaths/min, and temperature 101.8°F. Pulse oximetry showed 94% saturation on ambient air. Chest auscultation revealed markedly decreased breath sounds on the left lung base with egophony. The remainder of the examination was unremarkable except for the presence of scaly silver erythematous lesions on the extensor surfaces, elbows and knees, consistent with psoriasis. Upon admission, the white blood cell count was 22.6 10 3 /L, with 76% neutrophils and 9% band forms. Arterial blood gas showed a pH of 7.44, PCO 2 of 40.4 mm Hg, PO 2 of 70 mm Hg, and saturation of 94.2% on ambient air. The results of the other laboratory tests were normal. Chest x-ray revealed consoli-dation of the left lower lobe with suggestion of collapse secondary to soft tissue density or pleural effusion (Fig. 1). The patient was admitted with a diagnosis of commu-nity-acquired pneumonia, and he was started on intravenous ceftriaxone and azithromycin after obtaining sputum and blood samples for cultures and urine sample for Legionella antigen. On the second day of admission, the patient improved symptomatically, became afebrile, and maintained good ox-ygenation on room air. He continued to improve through the fifth day of hospitalization, at which point he was discharged to home on a 1-week course of oral levofloxacin and bron-chodilators. The results of blood and sputum cultures and Legionella urinary antigen were unrevealing. The decision not to proceed with thoracentesis was made after the patient declined the procedure because of his concern about the risks, including pneumothorax. When seen in follow-up 7 days after discharge, the patient showed continuous signs of clinical improvement. A computed tomography (CT) scan of the chest without contrast was obtained 3 weeks after discharge for further assessment of the prior chest x-ray abnormality. Evaluation of the film by the radiologist the next day revealed a large area of encap-sulated fluid in the left lower lobe measuring 9.0 7.5 cm, with an air-fluid level, consistent with an abscess (Fig. 2). His white blood cell at that time was 8.6 10 3 /L, he was asymptomatic, and he was clinically back to his baseline with the continued use of only bronchodilators. The patient was not told about the results of the CT scan, as he temporarily moved out of the state and was lost to follow-up until seen again 3 months later. He was asymp-tomatic when evaluated in the clinic and denied any receipt of antibiotics in the interim period. Chest auscultation showed normal breath sounds with no egophony. Three months after the initial CT scan of the chest, a repeat CT scan was obtained that surprisingly showed only mild pleural thickening on the left lower base of the left lung, which most likely represents residual scarring or fibrosis, without any evidence of an abscess or pleural effusion (Fig. 3). The patient did not have pulmonary function tests at that time but continued on his bronchodilator regimen without any further antimicrobial therapy.
    Clinical Pulmonary Medicine 01/2006; 13(2). DOI:10.1097/01.cpm.0000203738.76590.da
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    ABSTRACT: Lung abscesses are cavitating lesions containing necrotic debris caused by microbial infection. Patients with chronic lung disease, bronchial obstruction secondary to cancer, a history of aspiration or risk of aspiration caused by alcoholism, altered mental status, structural or physiologic alterations of the pharynx and esophagus, neuromuscular disorders, anesthesia, are among others at higher risk of developing lung abcess.The main bacteriological characteristics, the diagnosis, therapy and prognosis are considered. The problem of antimicrobial resistance is also referred.
    01/2008; 14(1):141–149. DOI:10.1016/S2173-5115(09)70248-9
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    ABSTRACT: Bronchiectasis and lung abscess are generally treated medically, reserving surgery for when medical treatment has failed. Current goals of surgical therapy for bronchiectasis are to offer possible cure and better quality of life after medical treatment has failed and to resolve and prevent complications, such as empyema, severe hemoptysis, and lung abscess. Whenever possible, complete resections of localized disease should be done, reserving palliative resections to selected diffuse bronchiectasis with localized severe disease. Most lung abscesses can be successfully treated medically provided early diagnosis and prompt treatment are instituted.
    Thoracic Surgery Clinics 08/2012; 22(3):333-44. DOI:10.1016/j.thorsurg.2012.04.008 · 0.77 Impact Factor