Lung abscess


  • Localized, suppurative necrotizing process occurring within the pulmonary parenchyma
  • Microbiology
    • Community-acquired: anaerobes mostly aspiration, anaerobic bacteria from oral cavity: peptostreptococcus, prevotella, bacteroides, fusobacterium species
    • Hospital-acquired: Staph, E coli, Klebsiella, pseudomonas, legionella


  • Aspiration pneumonia (7-14 days to become lung abscess)
  • Bacteremia from nonpulmonary infection
  • Influenza leading to Bacterial superinfection (e.g. S. Aureus)
  • Pulmonary infarction
  • Infection as a result of penetrating chest trauma
  • Primary and metastatic neoplasms
  • Granulomatosis with polyangiitis (Wegener's), sarcoidosis

Clinical Features

  • Cough, fever, pleuritic chest pain, weight loss, night sweats (generally over course of several weeks)
    • Tachycardia, tachypnea, or fever may be absent


Differential Diagnosis

  • Cavitary lesion with air-fluid level
  • Infected bullae
  • Pleural fluid collection with bronchopleural fistula
  • Loop of bowel extending through diaphragmatic hernia


  • CXR or CT Chest
  • Dense consolidation with air-fluid level inside of a thick-walled cavitary lesion
    • Air-fluid level indicates communication of abscess cavity with a bronchiole


  • Medical management will successfully treat 70-90% of lung abscesses
    • Drainage occurs spontaneously from communication of cavity with tracheobronchial tree
    • Bronchoscopic drainage may result in seeding other parts of the lung
  • Antibiotics


  • Admit

See Also


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