Lung abscess

Key points

Lung abscess

Often caused by pneumonia - parenchymal infection → parenchymal necrosis → cavitation → abscess formation

May be secondary to foreign body or lung malformation, septic emboli from endocarditis

Organisms: Streptococcus pneumoniae, Staphylococcus aureus, S. pyogenes and Pseudomonas aeruginosa

Most primary abscesses in posterior RUL, RLL + LLL

CXR may show cavity with air fluid level

90% respond to physiotherapy (postural drainage) + Antibiotics

IR guided drainage shortens hospital stay if not responding

If central abscess not amenable to peructaneous drain - do bronchoscopic drainage

Pulmonary resection sometimes needed if:

• Clinically unstable after 7 days max therapy

• Chronic abscess >3 months

• Fistula >7 days

• CPAM

If fungal ball - may need wedge resection or lobectomy - can be mistaken for metastasis

Pneumatocoele

Air filled cyst

Peribronchial trauma dissects down air corridors - forms sub-pleural emphysema

Can be secondary to staphylococcal pneumonia, abscess, trauma

Most resolve

May need to be decompressed if causing pneumothoraces (especially tension)

References

Holcomb and Ashcraft’s Pediatric Surgery, 7th edition, 2020, Chapter 23 Acquired lesions of the Lung and Pleura