Lung abscess

Last reviewed: 28 Apr 2022
Last updated: 02 Jul 2021

Summary

Definition

History and exam

Key diagnostic factors

  • positive past medical history
  • fever
  • productive cough
  • cardiac murmur
  • cavernous (amphoric) breath sounds
More key diagnostic factors

Other diagnostic factors

  • pleuritic chest pain
  • constitutional symptoms
  • cachexia
  • pallor
  • gingival disease
  • halitosis
  • absence of gag reflex
  • dyspnea
  • hemoptysis
  • rigors
  • weakness
  • arthralgia
  • hemorrhagic lesions
  • inspiratory crackles
  • bronchial breathing
  • decreased breath sounds
  • unilateral fixed rhonchus
Other diagnostic factors

Risk factors

  • predisposition to aspiration of gastric contents
  • poor dental hygiene and tooth extraction
  • bronchial obstruction
  • immunosuppression
  • chronic illness
  • extrapulmonary sepsis
  • pneumonia
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC
  • chest x-ray
  • sputum Gram stain
  • sputum culture
  • blood culture
  • empyema fluid culture
More 1st investigations to order

Investigations to consider

  • CT chest
  • bronchoscopy
  • quantitative cultures of protected specimen brushings
  • quantitative cultures of protected bronchoalveolar lavage samples
  • percutaneous needle aspiration and culture
  • sputum cytology
  • lung ultrasound
  • echocardiogram
  • rapid enzyme-linked immunosorbent assay (ELISA) for D-dimer
  • multidetector CT thorax
  • ventilation-perfusion scan
More investigations to consider

Treatment algorithm

ACUTE

low probability of gram-negative or multiresistant organism

high probability of gram-negative or multiresistant organism

ONGOING

low probability of gram-negative or multiresistant organism

high probability of gram-negative or multiresistant organism: with or without penicillin/cephalosporin allergy

Contributors

Authors

Ioannis P. Kioumis, MD, PhD
Ioannis P. Kioumis

Professor of Pulmonary Medicine and Infectious Diseases

Aristotle University of Thessaloniki

Respiratory Failure Clinic

General Hospital G. Papanikolaou

Thessaloniki

Greece

Disclosures

IPK declares that he has no competing interests.

Georgia G. Pitsiou, MD, PhD
Georgia G. Pitsiou

Associate Professor in Pulmonary Medicine

Aristotle University of Thessaloniki

Respiratory Failure Clinic

General Hospital G. Papanikolaou

Thessaloniki

Greece

Disclosures

GGP declares that she has no competing interests.

Peer reviewers

William G. Cheadle, MD

Professor of Surgery

University of Louisville

Associate Chief of Staff for Research and Development

VAMC Louisville

Louisville

KY

Disclosures

WGC declares that he has no competing interests.

Nicholas Maskell, MD

Senior Lecturer and Consultant Physician

North Bristol Lung Centre

Southmead Hospital

Bristol

UK

Disclosures

NM declares that he has no competing interests.

Najib Rahman, BM, BCh, MA (Oxon), MRCP (UK)

MRC Training Fellow and Specialist Registrar, Respiratory Medicine

Oxford Centre for Respiratory Medicine

Churchill Hospital

Oxford

UK

Disclosures

NR declares that he has no competing interests.

Philip W. Ind, BA (Cantab), MB BChir, MA (Cantab), FRCP

Consultant Physician

Honorary Senior Lecturer

Imperial College Healthcare Trust

Hammersmith Hospital

London

UK

Disclosures

PWI declares that he has no competing interests.

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