Lung abscess – Symptoms , Risk Factors , Treatments, and more

What is a Lung abscess?

A Lung abscess is a pus-filled cavity in the lung tissue caused by a microbial, usually a bacterial infection. It is a necrotising infection caused usually caused by aspiration of oral secretions by a semi-conscious or an unconscious patient or during anaesthesia or sedation. 

Types of Lung abscesses

They are classified as primary and secondary. 

1. Primary abscesses are infectious in origin, caused by aspiration in an otherwise healthy host.

2. Secondary abscesses occur in a pre-existing lung condition causing obstruction such as bronchogenic carcinoma or an immunocompromised patient.

What are the symptoms of a Lung abscess?

Symptoms usually occur over weeks to months. 

They include,

1. Fever

2. Productive cough, sometimes blood in sputum

3. Night sweats

4. Weight loss

5. Chest pain

6. Shortness of breath

7. Bad breath

8. Cachectic at presentation

What are the risk factors for developing a Lung abscess?

Risk factors for developing aspiration are

1. Alcoholism

2. Seizure disorder

3. Neuromuscular disorders

4. Drug overdose

5. General anaesthesia

6. Stroke 

How can a Lung abscess be diagnosed?

• Chest X-ray
• CT Scan of the thorax for better visualisation 
• Sputum culture to isolate the organism
• Bronchoscopy, if needed to exclude cancer or to get diagnostic material, if sputum is not available to isolate the offending organism
• Pleural fluid culture

How can a Lung abscess be treated?

Antibiotics – Usually intravenous

Drainage of the abscess – Percutaneous, endobronchial or surgical drainage of the abscess. Usually performed after failure of antibiotic therapy (approximately 10%). The preferable mode of drainage is usually decided based on the morphology of the abscess cavity and the contents. 

Surgery – Lobectomy, that is, removal of a single lobe of the lung or pneumonectomy, which is the removal of one entire lung, is performed for multiple, small or large abscesses resistant to antibiotics. Segmental resection is the removal of a small segment of the lung, usually suffices for small abscesses less than 6 cm cavity diameter. 

What are the complications of a Lung abscess?

a. Rupture into pleural space causing empyema

b. Bronchogenic spread causing multiple abscesses

c. Formation of bronchial fistula accompanied by pneumothorax

d. Pulmonary haemorrhage

e. Spread to distant areas like the brain, cerebral abscess

f. Sepsis

g. Lung fibrosis, bronchiectasis

h. Secondary amyloidosis

Conclusion

A very life-threatening situation to be in. One must seek immediate help in such a case, plus in a hospital, the nurse or the attendee of the patient should be aware of the patient condition to intervene promptly. A salvageable lung can be cured almost completely, giving a new life to the patient.

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