| A lung abscess is a pocket of pus that collects where lung tissue was destroyed.
Lung tissue can be destroyed by aspiration pneumonia, obstruction of an airway by a foreign body, or a tumor in the lung. The dead tissue provides a breeding ground for many types of microorganisms. As the organisms multiply, they further destroy the tissue and create a cavity in the lung that fills with very foul-smelling pus. Lung abscesses can occur singularly or in groups. They are often accompanied by pus in the space between the lungs and chest wall (empyema).
The most common organisms to cause abscess formation are bacteria that multiply in places without oxygen (anaerobic bacteria). Bacteria from the nose and mouth that are normally inactive (dormant) because of the high oxygen level there can be aspirated into the lung, where they become active. Dental problems (poor dentition) can lead to an overgrowth of various bacteria that can also be aspirated into the lungs.
Although almost everyone aspirates very small amounts of oral secretions, lung abscesses generally occur when a large amount of secretion is aspirated. Individuals who have seizure disorders, have had a loss of consciousness due to anesthesia or coma, or have poor control of their swallowing are more likely to aspirate secretions and thus develop lung abscesses. Aspiration can be seen in severe cases of reflux esophagitis, and may initially present as nocturnal asthma. Primary lung disorders increase susceptibility as well.
Because of the increased incidence of periodontal disease among the elderly, they are more prone to lung abscesses. Individuals with immune system deficiencies such as AIDS, or with a chronic disruption of airflow into or out of the lungs (chronic obstructive pulmonary disease, or COPD) are also at higher risk. Another risk factor for lung abscess is alcohol abuse. |
Source: Medical Disability Advisor
| History: Symptoms may include fever, a vague feeling of illness (malaise), cough, weight loss, a foul taste in the mouth, and increased sputum production that is foul smelling or possibly bloody. Individuals may also complain of shortness of breath, diminished appetite (anorexia), night sweats, and chest pains near the ribs. The individual may report a history of some predisposing factors such as tooth decay and periodontal disease, recent anesthesia, or difficulty swallowing. Many individuals have a history of recent diagnosis and treatment for pneumonia. A recent penetrating chest trauma should raise a clinical suspicion for empyema. Physical exam: The individual may be feverish (temperature elevated but usually not greater than 102° F [38.9° C]), appear to lack vigor, and have a weight loss since last seen and a foul mouth odor. There may also be evidence of poor dental care and hygiene. Listening to breath sounds through a stethoscope (auscultation) usually reveals a decrease in breath sounds in the area of the abscess and abnormal breath sounds similar to pneumonia in other parts of the lung. Tests: A chest x-ray is the cornerstone for diagnosis of lung abscess. Other tests that determine the type of organisms present in the lungs include sputum culture and culture of fluid withdrawn through the trachea (transtracheal aspiration). A complete blood count (CBC) with differential may reveal a leukocytosis. Bronchoscopy (using a viewing instrument passed down through the trachea to examine the bronchi air passages) may be necessary to rule out bronchial obstruction or tumor. A blood culture or a culture of the pleural fluid may be done by a needle puncture through the chest wall (thoracentesis). An arterial blood gas determination helps assess respiratory adequacy. |
Source: Medical Disability Advisor
| Treatment consists of antibiotic therapy, drainage of the pus, and treatment of the underlying or associated conditions. In general, antibiotics are given intravenously for the first week and then followed by oral antibiotics for 4 to 8 weeks. Treatment is continued until the individual's chest x-ray is cleared, even though symptoms may have resolved much earlier. The use of a diagnostic bronchoscopy is reserved for individuals who do not respond well to treatment.
If there is a significant collection of pus in the pleural cavity (empyema), a drainage tube (tube thoracostomy) may need to be surgically inserted between the lung and chest wall.
Treatment may also include fever-reducing medication (antipyretics) and cough suppressants, increased fluid intake, rest, and a program to increase nutritional intake if the individual has lost a significant amount of weight. Dental or swallowing problems need to be addressed on an individual basis to prevent recurrence. If the abscess appears to be caused by severe periodontal disease, the teeth may need to be removed and dentures built.
If a lung abscess is resistant to treatment (refractory), or the area begins to hemorrhage massively, surgery may be necessary to remove the segment or lobe of the lung involved (segmentectomy or lobectomy). Surgery may also be necessary if the abscess is caused by bronchial obstruction or a tumor. |
Source: Medical Disability Advisor
| Once antibiotic treatment is initiated, the individual begins to feel better. Although symptoms usually resolve within 2 weeks, the total resolution of the abscess takes 4 to 8 weeks. Healing may take longer if the abscess is extremely large, the individual has compromised healing or immune system, or the abscess requires surgical drainage. With antibiotics, most patients improve, with cure rates documented at 90% to 95% (Sharma).
Drainage of the fluids associated with the abscess helps the individual recover from the effects of the disease and may speed the healing process. |
Source: Medical Disability Advisor
| Individuals typically undergo chest physical therapy to promote drainage of the lung. A physical therapist uses techniques such as chest percussion and productive coughing, which help to vibrate the lungs and eliminate secretions. Deep-breathing exercises that help to expand the lungs and increase respiratory efficiency may also be part of therapy. |
Source: Medical Disability Advisor
| Complications occur when the organisms breeding in the lung abscess break free, infecting other areas of the lung and forming more abscesses. Pus can collect within the pleural cavity (empyema). The destruction of lung tissue by microorganisms can cause damage to large vessels in the lungs and lead to a life-threatening hemorrhage or can cause a hole to develop between a large airway of the lungs and the space between the lungs and chest (bronchopleural fistula). Of even greater concern is the possibility of the organisms migrating to the lining of the brain and forming a brain abscess.
Other complications include adult respiratory distress syndrome, rupture of the abscess, inflammation of the membrane surrounding the heart, or chronic inflammation of the lung. |
Source: Medical Disability Advisor
| Moderate to heavy physical activity may need to be modified during the recovery period. Dust and fumes also need to be avoided during this time due to the individual's compromised lung function. Respiratory protection may be necessary. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have a history of aspiration pneumonia or obstruction of airway by a foreign body?
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Is individual at greater risk due to impaired consciousness, seizure disorders, or alcohol intoxication or because of poor control of swallowing?
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Does individual have a history of tooth decay or periodontal disease?
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Are immune system deficiencies (immunocompromised), chronic obstructive pulmonary disease (COPD), or lung tumor(s) present?
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Does individual complain of fever, a vague feeling of illness (malaise), cough, weight loss, a foul taste in the mouth, or increased sputum production that is foul smelling or possibly bloody? Shortness of breath, diminished appetite (anorexia), night sweats, and chest pains near the ribs?
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Were chest x-rays taken and a bronchoscopy done?
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Were sputum culture and culture of fluid from the trachea (transtracheal aspiration) obtained?
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Were blood cultures or a culture of the pleural fluid required?
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Was blood drawn for measurement of arterial blood gases (ABGs)?
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Was the diagnosis of lung abscess confirmed?
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Does chest x-ray show abscess shrinkage?
Regarding treatment:
- Were antibiotics given intravenously for the first week and then followed by oral antibiotics for 4 to 8 weeks?
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Was antibiotic specific to the organism causing the infection?
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Did individual complete taking the antibiotic, as prescribed?
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Is antibiotic resistance an issue?
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Was antibiotic therapy continued until individual's chest x-ray cleared?
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Was chest physical therapy given to promote drainage of the lung?
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Was surgical insertion of a tube (chest tube) between the lung and chest wall required to drain pus collected in the pleural cavity (empyema)?
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Did treatment include fever-reducing medication (antipyretics) and cough suppressants, increased fluid intake, rest, and a program to increase nutritional intake, as needed?
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Were dental and swallowing problems addressed?
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If the abscess was resistant to treatment (refractory) or hemorrhage occurred, was surgery done to remove the segment or lobe of the lung involved (segmentectomy or lobectomy)? Was surgery successful?
Regarding prognosis:
- Was sufficient time given for the abscess to heal?
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Was individual absolutely compliant with the antibiotic regimen?
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Is length of recovery affected by the size of the abscess, a compromised immune system, or the need for surgical drainage?
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If the abscess has not been drained, should it be drained now to facilitate healing?
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Would individual benefit from consultation with a specialist (pulmonologist, infectious disease specialist)?
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Have complications occurred from the release of microorganisms into other areas of the lung, causing damage to large blood vessels in the lungs or a bronchopleural fistula?
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Have microorganisms migrated to the lining of the brain, forming a brain abscess?
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How will complications be treated, and what is the expected outcome with treatment?
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Source: Medical Disability Advisor
| Sharma, Sat. "Lung Abscess." eMedicine. Eds. Stephen P. Peters, et al. 11 Nov. 2004. Medscape. 10 Dec. 2004 <http://emedicine.com/med/topic1332.htm>. |
Source: Medical Disability Advisor
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