Table of ContentsView AllTable of ContentsSymptomsComplicationsCausesDiagnosisTreatmentPrognosis
Table of ContentsView All
View All
Table of Contents
Symptoms
Complications
Causes
Diagnosis
Treatment
Prognosis
This article present lung abscess symptoms and causes, as well as how a lung abscess is diagnosed. It discusses how a lung abscess is treated and what the long-term outlook is for people diagnosed with a lung abscess.
Lung Abscess Symptoms
The symptoms of a lung abscess may worsen rapidly, or they can come on slowly and insidiously.
Abscesses are described as:
Early signs and symptoms may include:
Later signs and symptoms may include:
Everything You Need to Know About Punctured Lung
Lung Abscess Complications
If a lung abscess persists or if the diagnosis is delayed, complications may occur.
Complications of an untreated lung abscess can include:
What to Know About Amyloidosis
Causes of a Lung Abscess
Lung abscesses may be primary or secondary. A primary lung abscess develops in a region of pneumonia or another lung disease. A secondary lung abscess occurs when an infection from another region of the body spreads to the lungs.
Abscesses can be single or multiple. Multiple abscesses tend to occur with pneumonia or due to sepsis.
Primary Lung Abscess Causes and Risk Factors
Some conditions that directly affect the lungs may predispose to a lung abscess.
How Do Chemo and Radiation Affect the Immune System?
Secondary Lung Abscess Causes
Causes of secondary lung abscess include:
Risk Factors
Risk factors for a lung abscess include:
What Is the Most Likely Cause of Lung Abscess?Alcohol misuse is the most common risk factor for lung abscess. It leads to aspiration, the most common cause of a lung abscess. This leads to tissue death in seven to 14 days.
What Is the Most Likely Cause of Lung Abscess?
Alcohol misuse is the most common risk factor for lung abscess. It leads to aspiration, the most common cause of a lung abscess. This leads to tissue death in seven to 14 days.
An Overview of Aspiration Pneumonia
Pathogens (Bacteria and Other Organisms Present in the Abscess)
Lung abscesses most often contain a combination of both aerobic (bacteria that live in oxygen) and anaerobic bacteria,with an average of six or seven different species present.
The type of bacteria present varies depending on the underlying cause, whether the infection begins in the community or the hospital setting, and geography.
Anaerobic bacteriaare usually most predominant and can include:
Aerobic bacteriaare also commonly present, especially in people who are immunocompromised.
These may include:
Parasites
Fungi
Bacteria Associated With Underlying Causes
The types of bacteria found in an abscess are associated with the underlying cause and risk factors.
For example:
Responsible Bacteria May Be Changing
In the past, anaerobes were the predominant bacteria present in community-acquired abscesses (developed outside of the hospital), with Streptococcus following as the second most common cause.
This appears to be changing, and now Klebsiella is commonly found in community-acquired abscesses.Klebsiella is associated with underlying diabetes.
Diagnosing Lung Abscess
A lung abscess may be suspected based on symptoms and risk factors, as well as physical findings.
On physical exam, a fever is common. Your healthcare professional may hear bronchial breath sounds and the area overlying an abscess may sound dull when the chest is tapped. This is described as dullness to percussion.
What Are Abnormal Breath Sounds?
Imaging
Early on, a chest X-ray may show infiltrates (evidence of pneumonia) without an obvious abscess present. Chestcomputerized tomography(CT) is the most reliable test, and an ultrasound of the lungs may be helpful in evaluating an abscess, especially in children. CT is also helpful in distinguishing between a lung abscess and empyema.
Some imaging changes associated with a lung abcess:
Bacterial Analysis/Culture
A sputum sample (sample of coughed up phlegm) is sometimes taken but tends to be inaccurate.
Blood culturesare often negative when anaerobes are the predominant type of bacteria present because these organisms can take longer to grow in the blood.
Differential Diagnosis
An important first step in evaluating a lung abscess is to distinguish an abscess from an empyema, though an empyema may occur as a complication of an abscess. On imaging, a lung abscess appears as a round cavity inside the lungs, whereas an empyema is located in the pleural space (outside the lungs or between the lungs and chest wall).
There are a number of conditions other than abscesses that may cause cavitation in the lungs.
Some of these include:
Lung Abscess Treatment
Antibiotics alone are often sufficient in treating a lung abscess and are effective roughly 80% of the time. Drainage or surgery is seldom needed for the treatment of lung abscesses.
Drainage is the preferred method of treatment for abscesses in many other regions of the body.
Antibiotics and Lung Physiotherapy
A combination of broad-spectrum antibiotics is most often used to treat the variety of bacteria present. Antibiotics are often started intravenously and continued for four weeks to six weeks or until evidence of the abscess is no longer seen on imaging studies.
With abscesses due to fungi and parasites, as well as infections with Mycobacterium, Actinomyces, or Nocardia, a longer duration of treatment may be needed—possibly up to six months.
If the abscess doesn’t improve with antibiotics, other treatments may be needed.
Lung physiotherapy and postural drainage are frequently helpful and often are combined with antibiotic treatment.
Percutaneous or Endoscopic Drainage
If a lung abscess doesn’t respond to antibiotic therapy (less than 10% of cases), drainage may be needed. This is usually considered if no improvement is noted after 10 to 14 days of antibiotics.
Drainage may either be done via a needle inserted through the chest wall into the abscess (percutaneous drainage) or via a bronchoscopy and endobronchial ultrasound (endobronchial drainage). Endobronchial drainage may be considered a better option for abscesses that are centrally located and away from the pleura when there is a risk of puncturing lung tissue, but percutaneous drainage is done more often.
Surgery
In very rare cases, surgery may be required. The most common procedures are a lumpectomy or segmentectomy in which the abscesses and some surrounding tissue are removed. This can often be done with minimally invasive surgery (video-assisted thoracoscopic surgery, or VATS).
Indications for surgery may include:
Prognosis (Outcome)
With timely antibiotic treatment, the prognosis of a lung abscess often depends on the underlying cause, and many lung abscesses resolve without any long-term problems.
Prompt recognition and treatment of a lung abscess are important for reducing the risk of complications.
As with many conditions, prevention is key. Good dental hygiene, prompt medical attention for suspected pneumonia, careful management of blood sugars if you have diabetes, and airway management can help reduce your risk.
Summary
Diagnosis typically includes chest imaging and testing of sputum samples. Antibiotics can treat a lung abscess effectively in about 80% of cases, with drainage or surgery rarely needed. With treatment, most people will recover from a lung abscess.
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Umamoto K, Horiba M.Lung abscess as a secondary infection of COVID-19: A case report and literature review.J Infect Chemother. 2023 Jul;29(7):700-702. doi:10.1016/j.jiac.2023.02.005.
Boucher B, Virlan D, Buddharaju V, Chaudhari S.Conservative Approach and Management of Complicated Lung Abscess.Cureus. 2022 Nov 26;14(11):e31910. doi:10.7759/cureus.31910.
Cai XD, Yang Y, Li J, et al.Logistic Regression Analysis of Clinical and Computed Tomography Features of Pulmonary Abscesses and Risk Factors for Pulmonary Abscess-Related Empyema.Clinics. 2019. 74:e700. doi:10.6061/clinics/2019/e700
Nicolini A, Cilloniz C, Senarega R, Ferraioli G, Barlascini G.Lung Abscess Due to Streptococcus Pneumoniae: A Case Series and Brief Review of the Literature. Pneumonologia I Alergologia Polska. 2014. 82(3):276-285. doi:10.5603/PiAP.2014.0033
Kuhajda I, Zarogoulidis K, Tsirgogianni I, et al.Lung Abscess-Etiology, Diagnostic and Treatment Options.Annals of Translational Medicine. 2015. 3(13):183. doi:10.3978/j.issn.2305-5839.2015.07.08
Long, S. S., Prober, C. G., & Fischer, M. (2018).Principles and practice of pediatric infectious diseases. Philadelphia, PA: Elsevier.
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