Lung abscess

Question 1

Lung abscesses most commonly form secondary to what?

Answer 1

Aspiration pneumonia

Question 2

Risk factors for aspiration

Answer 2

poor dental hygiene
previous stroke
reduced consciousness

Question 3

Other mechanisms of development of lung abscess

Answer 3

1. haematogenous spread (e.g. secondary to infective endocarditis)
2. direct extension (e.g. from an empyema)
3. bronchial obstruction (e.g. secondary from a lung tumour)

Question 4

Lung abscesses are typically polymicrobial. TRUE/FALSE?

Answer 4

TRUE

Question 5

Monomicrobial causes of lung abscesses

Answer 5

Staphylococcus aureus
Klebsiella pneumonia
Pseudomonas aeruginosa

Question 6

Clinical features of lung abscess

Answer 6

• night sweats/weight loss
• fever
• productive cough
• foul-smelling sputum
• haemoptysis (rare)
• chest pain
• dyspnoea

Question 7

Describe the presentation with lung abscess compared to pneumonia

Answer 7

Presentation is similar but abscess is more subacute (i.e. over weeks)

Question 8

Signs of lung abscess on examination

Answer 8

dull percussion
bronchial breathing
clubbing may be seen

Question 9

Signs of abscess on CXR

Answer 9

• fluid-filled space within an area of consolidation
• air-fluid level is typically seen

Question 10

Other relevant investigations in a potential lung abscess

Answer 10

Sputum culture
Blood cultures

Question 11

Management of lung abscess

Answer 11

IV antibiotics
if not resolving - percutaneous drainage/ surgical resection