Lung abscess in childhood

Lung abscess continues to be a significant problem in childhood. Eighty-three cases of this condition have been reviewed. From the available data these have been found to fall into two groups which have been classified as primary and secondary. Consideration of the aetiology has revealed that the commonly quoted predisposing features, namely tonsillectomy and foreign body aspiration, are no longer of such paramount importance. The causative organism is a staphylococcus in the majority of cases. This is at variance with other published findings. The more general use of antibiotics in all respiratory diseases is responsible for some of the changing patterns noted. The management of lung abscess in childhood also presents a changing picture. Bronchoscopy is being supplanted by more conservative measures.     

Lung abscess secondary to xanthogranulomatous pyelonephritis

In a patient with xanthogranulomatous pyelonephritis the initial clinical and radiological picture suggested a diagnosis of lung abscess.     

Lung abscess: a changing pattern of the disease

Alcoholic stupor with aspiration has been the most commonly recognized cause of lung abscess. Eighty-nine patients treated for lung abscess in a large community hospital from 1968 through 1982 have been described. Forty-six percent of these patients were 60 to 80 years of age. The most common predisposing factors included pneumonia, immunosuppression steroid therapy, carcinoma at a distant site, alcoholism, and lung cancer. Surgical therapy was employed in 23 patients when there was suspicion of cancer and failure to improve with medical management. Fifty-seven percent of patients were either cured or improved at the time of discharge. Twenty-nine percent died from other causes during hospitalization, and 9 percent died as a direct result of the abscess. Thus, the patients encountered in the community hospital setting tended to be older and had a wide variety of illnesses that precipitated the development of lung abscesses.     

Lung abscess due to retained gallstones with an adenocarcinoma

We describe a patient who had a right lower lobe mass containing calcifications consistent with gallstones develop 3(1)/(2) years after laparoscopic cholecystectomy. Thoracotomy revealed a chronic abscess containing pigmented gallstones and an adjacent area of bronchoalveolar adenocarcinoma involving both N1 and N2 lymph nodes.     

Lung abscess which ruptured during the medical treatment of lung abscess; report of a case

63-year-old man was admitted to our hospital with fever and cough for about 2 months. Laboratory data showed marked inflammatory changes, and chest computed tomography (CT) scans revealed right-sided hydrothorax, atelectasis of the right middle lobe, and a cystic mass in the right middle lobe. We diagnosed the patients as having lung abscess and empyema. Following the intravenous antibiotic chemotherapy, symptoms and laboratory data showed the improvement, however, on the 11th hospital day, he developed high fever again. A chest CT showed pneumopyothorax suggesting the rupture of lung abscess. Since the chest tube drainage was ineffective, open chest surgery was performed. Curettage of both thoracic and abscess cavity with closure of air leakage successfully cured the pyothorax.     

Lung abscess revisited. A survey of 184 cases.

One hundred eighty-four patients with lung abscess, admitted to the Hospital of the University of Mississippi between 1960 and 1982, were studied with respect to sex (149 men and 35 women), age (mainly fourth to sixth decades), location of abscess(es) (RLL, RUL, and LLL mainly), predisposing factors (aspiration in sensorium disorders, obstruction, gingivo-dental suppuration, immunoincompetence) and nonoperative (89%) and operative (11%) therapy, usually lobectomy. Data from the different decades were compared, but there were few major differences. Mortality rate was 22% in the 1960s, 25% in the 1970s, and 28% in 1980-1982. Major management problems involved massive pulmonary hemorrhage, impaired immune defenses, old-age debility, bronchopleural fistula with empyema, or very large cavity. Anaerobic bacteria predominate and penicillin is the treatment of choice. Incidence of operation is declining, but cases are more often complicated. Prognosis is good in the uncomplicated case.     

Lung abscess predicts the surgical outcome in patients with pleural empyema

Objectives  

Most cases of pleural empyema are caused by pulmonary infections, which are usually combined with pneumonia or lung abscess. The mortality of patients with pleural empyema remains high (up to 20%). It also contributes to higher hospital costs and longer hospital stays. We studied pleural empyema with combined lung abscess to determine if abscess was associated with mortality.     

Lung abscess: a neglected cause of life threatening haemoptysis.

Three cases who presented with life threatening haemoptysis are reported, all of whom required surgery to control the bleeding. In all three patients chronic lung abscess was responsible for the haemoptysis. Even in the absence of typical clinical or radiographic features of an abscess this diagnosis should be considered in any patient presenting with life threatening haemoptysis.