WHAT IS A LUNG ABSCESS?

A lung abscess is a region in the lung that becomes necrotic due to infection.  An abscess forms in the actual lung tissue called the parenchyma. There are two categories of lung abscess, primary and secondary. A primary abscess has its origin within the lung parenchyma itself while a secondary lung abscess is an infection that has spread from some other part of the body into the lungs.

Causes of a lung abscess

There are several causes of lung abscesses, which are as follows:

• Aspiration: This is when food or liquid particles end up in the lungs. This often leads to a lung abscess. Aspiration can happen if a person is sick or under the influence of alcohol or drugs. Aspiration often leads to pneumonia which then results in the abscess forming.
• Bacterial infections: Many types of bacteria have been implicated in causing lung abscesses, including those that are found in the gums. Some types of bacteria found in such abscesses include Bacteroides fragilis and Fusobacterium, Staphylococcus, and Streptococcus.
• Fungal infections: Aspergillus is one of the types of fungus that can cause lung abscesses to develop.
• Bronchiectasis: This is a condition where bronchi become too wide and damaged because of an infection such as pneumonia or tuberculosis.
• Necrotizing pneumonia: This is a type of pneumonia that damages the lungs very quickly causing necrosis of tissue. The result is an abscess on the lung from pneumonia.
• Poor dental and oral health: Bacteria spreading from the mouth and teeth into the lungs can cause an abscess, especially if the immune system is not strong.
• Bronchial obstruction: When there is a blockage in one of the bronchial tubes, mucus starts to accumulate and this can attract bacteria leading ultimately to a lung abscess.
• Sarcoidosis: An abnormal accumulation of inflammatory cells causing growths in various organs.
• Lung cancer: When a tumor blocks the bronchi or parts of the lung then accumulations of bacteria can grow.
• Silicosis: This is when nodules develop in the lungs after a person breathes in too much silica dust.
• Pulmonary embolism: This is a blood clot in the lungs.
• Rheumatoid nodules in the lungs: These nodules are caused by a very severe type of rheumatoid arthritis.

Lung abscess symptoms

Symptoms are very similar to the signs of other ailments of the respiratory system, such as pneumonia. An abscess in the lung is not the same as pneumonia, yet can be caused by a type of pneumonia and result in problems with lung function.

Symptoms of an abscess on the lung are as follows:

• Fever: Temperature is 38°C (101°F) or more.
• Dyspnea: This is difficulty in breathing.
• Night sweats
• Shivering
• A cough that produces foul-smelling sputum.
• The cough does not go away after several days or weeks.
• Coughing up blood
• Weight loss

Lung abscess complications

Patients with other respiratory illnesses such as COPD have a greater risk of complications than previously healthy patients. This is because lung damage is likely to be more severe in such patients.

There are serious complications if lung abscesses are not resolved. These are listed below.

• Calcification of the pleura: This is when the inflammation due to an abscess in the lungs, results in the membranes (pleura) of the lungs becoming calcified and stiff. The result is that chest movement and breathing becomes difficult.
• Bronchopleural fistula: In this case, a connection/path forms between the bronchus and the space between the lungs, and can result in death if untreated.
• Respiratory failure: This is when the cells cannot get enough oxygen or get rid of carbon dioxide quickly enough.
• Gangrene: A lung abscess from necrotizing pneumonia, if untreated can result in gangrene and septic shock. Septic shock causes hypotension, which damages organs. Septic shock has a high mortality rate of about 40%.

Lung abscess diagnosis

A physical exam noting the symptoms can lead a doctor to suggest a person go for further testing. Diagnostic methods used to detect a lung abscess include the following:

• X-ray of lung abscess: A lung abscess on an X-ray appears as a space that has both a liquid and gaseous component.
• CT scan of the chest area showing the lungs: On a CT scan an abscess looks like a rounded transparent area. The area will have thickish walls and be irregular in shape.
• Cultures of sputum: Sputum can be taken and left to grow out the organisms present in the lungs to identify the bacteria involved.
• Bronchoscopy: This is a method of visualizing the bronchi to check for the presence of obstructive lesions which can occur, for example, if cancer is present.

For insurance purposes the diagnostic code for a lung abscess is ICD-10. A proper diagnosis is needed for individuals who have private health insurance in order to ensure that there is coverage for procedures done to treat the lung abscess.

A lung abscess can be confused with other conditions such as empyema. Comparing a lung abscess vs empyema, the location of the structure becomes important. A pulmonologist may be needed to help in the diagnosis and treatment of a lung abscess.

Lung abscess treatment

There is a range of treatment options available for an abscess in the lungs. These are listed below.

• Drainage of the abscess: Removal of the purulent fluid and necrotic tissue is helpful and can be done by endoscopic means or by drainage through a chest tube placed into the chest.
• Antibiotic therapy: The first choice is clindamycin, then various combinations of antibiotics may become necessary such as ampicillin and sulbactam. Antibiotics may need to be given intravenously in very sick patients, and it can take a couple of weeks of treatment for the condition to be fixed.
• Pulmonary resection: For certain patients, surgical removal of the infected portion of the lung, including the abscess, may be needed.

Conclusion

There are many causes of an abscess on the lungs and it can lead to dangerous complications if not diagnosed and treated rapidly. A lung abscess can be confused with pneumonia but radiography can distinguish the two conditions. Treatment of an abscess requires antibiotics and sometimes drainage or surgery.

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