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.
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
2. Seizure disorder
3. Neuromuscular disorders
4. Drug overdose
5. General anaesthesia
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
g. Lung fibrosis, bronchiectasis
h. Secondary amyloidosis
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.
How to prevent a Lung abscess?
1.Providing attention towards airway protection
2. Proper positioning of a sick patient in the hospital, head-end elevation
3. Avoid oral feeding for semi-conscious and unconscious patients improving oral hygiene and proper dental care in elderly and debilitated patients
4. Patients with oesophageal disorders, such as scleroderma or a diverticulum, as well as those who have undergone oesophageal or gastric surgery predisposing to regurgitation; should be instructed on how to minimise the risk of aspiration by proper sleep position and by avoiding overfilling of the stomach before sleeping.
Is Lung abscess serious?
Yes, if left untreated, a Lung abscess can turn serious and fatal.
Can healthy people get Lung abscesses?
Lung abscess is usually a disease of the elderly and debilitated, alcoholics and immunocompromised patients.
Is Lung abscess curable?
Yes, Lung abscess is treatable and curable in 90% of the cases. A high risk of mortality occurs in secondary Lung abscesses.
Who treats a Lung abscess?
A physician treats a Lung abscess. He may refer you to a pulmonologist or a thoracic surgeon, if needed for bronchoscopy or a lobectomy, respectively.
Can a Lung abscess be fatal?
Yes, Lung abscess can be fatal in 5-10% of individuals.
What poor prognostic factors determine the outcome of a Lung abscess?
2. Right lower lobe
3. Bad general condition of the patient such as Anaemia, Hypoproteinaemia, immunocompromised state, alcohol or drug abuse.