Lung abscess – causes, symptoms, diagnosis and treatment

Proven content

Lung abscess is a condition of bacterial, purulent, usually limited inflammation of the lung tissue, combined with gangrene, i.e. necrosis in its central part. Fortunately, this disease is relatively rare today. The most common cause of lung abscess is lung cancer in adults, and foreign body aspiration in children.

What is a lung abscess?

Lung abscess is a condition characterized by inflammation of the lung tissue of a bacterial or purulent nature. Very often, necrosis of its central part is associated with an abscess. A disease occurs when an oil reservoir is formed in the area of ​​the lungs, surrounded by a fibrous capsule. In adults, a lung abscess usually occurs due to a lung tumor, while in young children it may be caused by foreign body aspiration. The disease should be treated in any case, as it can lead to fatal complications.

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The causes of lung abscess formation

As mentioned before, the most common cause of a lung abscess is the infiltration of a foreign body into the bronchus. Then, bronchial secretion begins to accumulate in the peripheral part of the respiratory tract, which creates good conditions for the formation of a bacterial infection and thus the formation of a pus reservoir. In adults, the disease is a common symptom of lung cancer. Lung abscess formation may also be related to a history of lung abscess.

The immediate cause of a lung abscess may be an infection caused by staphylococcus, Klebsiella pneumoniae, anaerobic bacteria and Pseudomonas aeruginosa.

In addition to the above-mentioned reasons, it is also worth mentioning the passage of gastric contents into the lumen of the bronchi, which also results in the formation of an abscess. These situations usually happen to people who have undergone CPR; suffering from excessive vomiting; have undergone gastric lavage and do not have a cough reflex. Then the disease develops very rapidly – gastric juice damages the lung tissue, which in turn leads to rotting of food debris and the development of bacterial pneumonia and abscess formation. On the other hand, in extreme cases, a lung abscess may appear due to improper treatment of pneumonia (usually lobar) or as a result of a complication of the inflammatory process of atelectasis or pulmonary infarction.

How is a lung abscess manifested?

The severity of symptoms is influenced by the location of the abscess, therefore, if the abscess is located superficially, the most common local symptoms include:

1. skin tenderness,
2. reddening of the skin,
3. warmth,
4. low-grade fever.

Symptoms of a lung abscess or abscesses are usually characterized by:

1. high fever,
2. chills
3. general malaise,
4. coughing
5. bronchial murmurs,
6. excessive removal of foul and cloudy mucopurulent sputum.

Lung abscess – diagnosis

In the diagnosis of a lung abscess, a detailed medical history with the patient and a physical examination are very important. The auxiliary tests performed in the diagnosis of the disease are laboratory tests: high levels of white blood cells and elevated CRP absolutely suggest that the body is undergoing inflammation. In addition, a chest X-ray is performed, during which the doctor sees a cavity located among the lung parenchyma, with liquid content inside.

In some patients, it is recommended to carry out bronchoscopy in order to collect histopathological material for examination. Sometimes, a culture is also performed to determine which pathogen caused the development of the abscess. The next diagnostic step is to assess the drug susceptibility of the cultured pathogen.

What are the treatments for a lung abscess?

The basic method of treatment is simultaneous implementation of antibiotic therapy and postural drainage. The postural drainage is used to empty the purulent contents from the sac by positioning the body according to the bronchial pathways. For example, when the abscess is on the left side, the patient’s body will be slightly twisted to the right so that the purulent contents are excreted towards the main bronchi. Each such pose session lasts approximately half an hour. The drug to be recommended in the first instance is benzylpenicillin given in combination with clindamycin.

The best treatment results are achieved by targeted antibiotic therapy, the choice of which depends on the result of the culture of purulent content, and then the antibiogram. Although the treatment is ideally suited to the patient, it can be long-term (sometimes several weeks).

In a situation where a lung abscess was caused by foreign body aspiration – bronchoscopy, i.e. its removal, should be performed.

Conservative treatment is also implemented, which should be used for at least six weeks. During this time, it should be monitored whether the lesions regress – if so – the lung abscess is chronic. A chronic abscess causes changes in the thick wall through which antibiotics hardly have a chance to penetrate. In this case, the patient should undergo surgical removal of a piece of lung tissue along with abscesses. Surgery may also be performed when:

1. there was a hemorrhage,
2. there is a suspicion of lung cancer,
3. the patient has a very large abscess,
4. the abscess was pierced into the pleural cavity.

How to prevent

Particular attention should be paid to careful and effective treatment of the inflammation of the lungs.