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Seven cases of lung abscess involving Klebsiella pneumoniae with or without other pathogens presented with gross expansion of the involved lobes or segments and severe clinical illness despite medical treatment. Operative management by rib resection and tube drainage was successful in each case, one of which was found to be an infected cryptococcoma. Postoperative bronchograms were made in six cases.
To assess the value of chest ultrasonography in the differentiation between a lung abscess and empyema, 50 patients, including 24 cases of lung abscess and 26 cases of empyema, were studied. The ultrasonographic characteristics of a lung abscess included an irregular wall width, a blurred outer margin, an oval or round shape, an acute chest wall angle and a negative pleural separation. The ultrasonographic characteristics of empyema were an uniform wall width, a sharp outer margin, a lenticular shape, an obtuse chest wall angle and a positive pleural separation. A new ultrasonographic scoring system was proposed; a positive finding for each of the features: sharp outer margin, lenticular shape, obtuse chest wall angle and positive pleural separation was assigned a score of 1, while a negative finding was assigned a score of zero. The total scores for the four features were then assessed. Ninety-six percent of the empyema cases scored 2 or more, while 96% of the lung abscess cases scored 1 or zero. The efficacy of differential diagnosis was 96%. We conclude that chest ultrasonography is a useful tool in the differentiation between lung abscess and empyema and that ultrasonography alone is sufficient to make a correct diagnosis in most cases.
Ten cases of giant lung abscess were treated by one-stage closed tube drainage after initial medical therapy. Sepsis or hemorrhage was relieved in all patients. There were no operative deaths, serious complications, or late recurrences. Three patients have subsequently died from bronchogenic cancer.
Experience with three patients with primary lung abscesses indicates that transtracheal catheter drainage of lung abscesses is a safe and beneficial procedure in childhood. The ability to drain abscesses not easily reached percutaneously will promote emptying and collapse of the abscess and provide bacteriological information which will enable the physician to select the correct antibiotics.
A case is reported with pneumomediastinum and mediastinitis complicating lung abscess in the lingula of a 77-year-old man. Causative factors were the association of virulent organisms having necrotizing properties in a host with diminished resistance and location of the cavity adjacent to the mediastinal pleura. A review of 1119 documented patients with lung abscess revealed that this complication has been reported only twice previously. Early surgical drainage combined with systemic administration of antimicrobial agents are the most effective therapeutic measures for mediastinal infection. Therefore, close observation is required of patients with lung abscess adjacent to mediastinal structures.
The availability of effective antimicrobial agents has greatly decreased the need for surgical intervention in patients who have a pyogenic lung abscess. We describe 3 patients with lung abscesses caused by gram-negative bacteria who failed to respond to medical treatment and who were believed to be unable to withstand lobectomy. Percutaneous insertion of a drainage tube directly into the abscess brought about a dramatic clinical response, with prompt closure of the cavity. This procedure provides an alternative to thoracotomy and lobectomy in treating lung abscesses that fail to respond to medical therapy.
A 58-year-old man presented with the clinical signs and symptoms of a large right upper lobe lung abscess. His course was complicated by diffuse bilateral necrotizing pneumonitis, and death occurred as a result of massive aspiration of lung abscess contents into uninvolved lung. At postmortem examination, an esophageal carcinoma with a direct fistulous communication with the abscess cavity was present. Although rare, asymptomatic malignant esophageal disease should be considered in the differential diagnosis of a lung abscess which does not follow a typical course.
Despite the rarity of lung abscess in children, 24 patients were treated at Harare Central Hospital during the 10 year period (1979 to 1988). The bacteriology and clinical findings of the 24 patients are presented. Bacteria were isolated from 18 patients. The most frequent isolates were Staphylococcus aureus, group A beta haemolytic streptococci, and Pseudomonas aeroginosa. Most of the abscesses followed measles, empyema or an episode of aspiration. The patients were managed with bronchoscopy, physiotherapy, and appropriate antibiotics, and had a mortality of 25%. Efforts at controlling measles as well as early and appropriate management of empyema are likely to reduce the number of lung abscesses in children.
Left upper lobe amoebic lung abscess without established hepatic amoebiasis in a young Black man is described and the pathogenesis is briefly discussed.
The experience with 45 patients with lung abscess over a three-year period at the University College Hospital (UCH), Ibadan, is presented. This study confirms the rarity of this disease among Nigerian children and its prevalence in young adults in the third and fourth decades of life. The most common presenting symptoms were purulent cough, chest pain, fever, and life-threatening hemoptysis which was the sole indication for emergency operation in 14 out of 16 patients who were treated surgically. The predominance of these abscesses in the right lung, especially in the superior segment of the lower lobe, supports the fact that aspiration of infected material, following depressed level of consciousness, esophageal obstruction, foreign bodies, and oral sepsis form the major causative factors in patients with lung abscess. The frequent association of sickle cell disease, bronchiectasis, hypertension, and pulmonary aspergilloma contribute significantly to the morbidity and mortality attendant to this disease in our environment. Twenty-nine patients were treated medically with five deaths and 16 patients were treated surgically with six deaths. The high operative mortality (37.5 percent) in this series was due to the extreme emergency conditions under which these patients were operated.
We compared the roentgenographic, bronchoscopic, and cytopathologic findings from 26 patients with carcinomatous lung abscesses (23 of which were within the tumor) with findings from 31 patients with simple lung abscesses. Despite well-described roentgenographic characteristics of the carcinomatous abscess, differentiation from a simple abscess was frequently not possible. Direct visual findings at the time of bronchoscopy were not helpful in the absence of an endobronchial lesion. Using sputums and cytological specimens from a single fiberoptic bronchoscopy, a diagnosis was made by cytopathology on initial hospitalization in 22 (88%) of 25 patients with carcinoma. No false-positive cytological studies were reported in the nonmalignant group despite the frequent presence of inflammation and infection.
Mycobacterium fortuitum rarely causes lung disease. Although treatment in the past has included intravenous antibiotics, this is the first report of a Mycobacterium fortuitum lung abscess that resolved with a prolonged course of oral ciprofloxacin alone. There is no evidence of recurrence 14 months after the end of treatment.
Aspiration pneumonitis and lung abscess generally involve anaerobic bacteria, which normally colonize the upper respiratory passages. The therapeutic response of these infections to parenteral penicillin G (49 patients) and parenteral clindamycin (35 patients) was compared to determine relative efficacy. No difference was discerned between these two agents in terms of time required for defervescence, roentgenographic clearing, and ultimate outcome. Seven patients with infections including Bacteroides fragilis were treated with penicillin G, and all responded well. These data indicate that penicillin G is the preferred agent for pulmonary infections involving anaerobic bacteria. Clindamycin is a suitable alternative for patients in whom penicillin G is contraindicated.
A patient with a staphylococcal lung abscess developed acute glomerulonephritis with clinical and pathological features typical of postinfectious glomerulonephritis. There was no evidence of streptococcal infection and the nephritis resolved following treatment of the abscess.
Two adolescents with acute anaerobic (putrid) lung abscess were seen during an influenza epidemic. One patient, who had a history of seizures and a dental infection, had a classic predisposition to this disease. In the second patient, the abscess was apparently acquired as a complication of influenza. In both cases, the preliminary diagnosis was staphylococcal pneumonia with pneumatocele. It is suggested that failure to consider an anaerobic cause in pulmonary infections, inappropriate specimens, transport and culture of anaerobic material, and the sensitivity of oral cavity-derived anaerobes to penicillin, serve to mask the true frequency of anaerobic lung infections in childhood and adolescence.
An endobronchial lesion with lung abscess in a patient with AIDS was due to Rhodococcus equi. The patient responded to triple chemotherapy.
An unusual presentation of Klebsiella pneumonia with lung abscess in a male child with no apparent predisposing factor is described.
Six infants 8 weeks of age or younger had lung abscesses treated in our medical center during the 20-year period of from 1957 to 1977. The duration of symptoms prior to diagnosis, the etiologic organisms, and the therapeutic approach differ from those in older children and adults. The pathogenic organisms were Escherichia coli, group B streptococcus, and Klebsiella pneumoniae, initial therapy with a penicillin and an aminoglycoside are indicated until identification and susceptibility results are available on the organism isolated from the abscess cavity. Previously undiagnosed cystic malformations of the lung were seen in two of the six patients. Surgical intervention is usually required in this age group.