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Lung Abscess

Lung abscess is a localized septic process in the parenchyma of the lungs. There are three main reasons for the development of lung abscess.
Decreased ability in immunological status:
Presentation of the microbial agents
  • Streptococcus
  • Staphylococcus Aureus
  • Anaerobic bacteria e.g. Clostridium
  • Pneumococcus
Obstruction of the airways or decreased function of the lungs:
  • Obstruction due to carcinoma
  • Intramural foreign body
  • Post-operative atelectasis
Other chronic respiratory sepsis:
  • Sinusitis
  • Tonsillitis
  • Dental infections
Lung trauma (primary or secondary)

Primary abscess occur when the pathological process in the lungs is main reason for the pus condensation e.g. pneumonia but typical primary reason is trauma.

Secondary abscess of the lungs appears due to the inflammatory processes and dissemination by haematogenous & lymphogenous (so-called contact ways).

All kinds of skeptical abscesses on the basis of mastitis and osteomyelitis should be considered as lung abscess. If the lung abscess occurs in the process of pneumonia, we call it as parapneumatic abscess and after on we call it as post or metapneumatic abscess.

Most commonly encountered microbes are streptococcal aerobes and pneumococcus which cause non-specific abscess but if abscess develops on the basis of specific flora as tuberculosis mycobacterium (acid fast) and/or by some anaerobic forms as clostridium then we call it as specific abscesses.

Clinical features:
  • High temperature
  • Fever
  • Chest pain (abscess is irritating pleura)
  • Dry cough with pain
  • Nausea and vomiting when intoxication occurs
  • Hyperemia (redness of the corresponding part of the face) is the most characteristic feature
Diagnosis:
Plain chest X-ray, which demonstrates a cavitating shadow and has the similar appearance as it occurs in the necrotic bronchial carcinoma. The diagnosis is confirmed with a combination of sputum culture and bronchoscopy.

Treatment:
Most acute abscesses resolve with the appropriate antibiotic therapy. The course of antibiotic is usually the highest permitted dose for a prolonged period of time. It is better for the lung abscess to drain via the bronchus and the contents are coughed up.

Surgically, opening of the abscess cavity with puncture is performed in the 7th or 8th intercostals space on the posterior scapular line and on the superior edge of the rib or through thoracotomy. Other medical therapy includes:
  • Antiseptics and antibiotic lavage
  • Vitamins (orally)
If the acute abscess lasts for more than 8 weeks then we have chronic lung abscess. This process is due to low drainage activity of the bronchus or bronchioles and low immunological state.

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This article has been written by Dr. M. Javed Abbas.
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13:39 06/02/2003