eMedicine Specialties > Pulmonology > Infectious Lung Diseases

Lung Abscess: Follow-up

Author: Nader Kamangar, MD, FACP, FCCP, FAASM,, Associate Professor of Clinical Medicine, Director of Hospitalist/Intensivist Program, Division of Pulmonary, Critical Care and Sleep Medicine, David Geffen School of Medicine at University of California Los Angeles; Associate Director, Combined Pulmonary and Critical Care Fellowship Program, Cedars-Sinai/Olive View-UCLA/West Los Angeles Veterans Affairs Medical Center
Coauthor(s): Curtis C Sather, MD, Fellow, Divison of Pulmonary/Critical Care Medicine, Cedars-Sinai Medical Center; Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital
Contributor Information and Disclosures

Updated: Aug 19, 2009

Follow-up

Further Inpatient Care

  • For the following reasons, inpatient care is advisable in patients with lung abscess:
    • Evaluation and management of patient's respiratory status
    • Administration of intravenous antibiotics
    • Drainage of the abscess or empyema as needed

Further Outpatient Care

  • In patients who have small lung abscess, who are not clinically ill, and who are reliable, outpatient care may be considered after obtaining appropriate diagnostic studies such as sputum culture, blood culture, and blood work.
  • Following initial intravenous antibiotic therapy, the patient may be treated on an outpatient basis for completion of prolonged therapy, which is often required for cure.

Deterrence/Prevention

  • Prevention of aspiration is important to minimize the risk of lung abscess. Early intubation in patients who have diminished ability to protect the airway from massive aspiration (cough, gag reflexes), should be considered.
  • Positioning the supine patient at a 30° reclined angle minimizes the risk of aspiration. Vomiting patients should be placed on their sides.
  • Improving oral hygiene and dental care in elderly and debilitated patients may decrease the risk of anaerobic lung abscess.

Complications

  • Complications of pulmonary abscess
    • Rupture into pleural space causing empyema
    • Pleural fibrosis
    • Trapped lung
    • Respiratory failure
    • Bronchopleural fistula
    • Pleural cutaneous fistula
  • In a patient with coexisting empyema and lung abscess, draining the empyema while continuing prolonged antibiotic therapy is often necessary.

Prognosis

  • The prognosis for lung abscess following antibiotic treatment is generally favorable. Over 90% of lung abscesses are cured with medical management alone, unless caused by bronchial obstruction secondary to carcinoma.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • A lung abscess may be asymptomatic in a small proportion of patients in the early stages; a chest radiograph may be helpful.
  • In any patient who is producing foul-smelling or bad-tasting sputum, suspect a lung abscess.
  • A shorter course of antibiotics may increase risk of a relapse. Therefore, antibiotic therapy for anaerobic lung abscess is prolonged, often extending up to 6-8 weeks.
  • A lack of response to antibiotic therapy should lead to consideration of a cavitating lung neoplasm, lung infarction, or Wegener granulomatosis.
 
Acknowledgments




More on Lung Abscess

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Differential Diagnoses & Workup: Lung Abscess
Treatment & Medication: Lung Abscess
Follow-up: Lung Abscess
Multimedia: Lung Abscess
References
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Further Reading

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Keywords

lung abscess, lung abscesses, necrotizing pneumonia, lung gangrene, necrosis of pulmonary tissue, lung cavities, aspiration pneumonia, periodontal disease, bacteremia, tricuspid valve endocarditis

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Contributor Information and Disclosures

Author

Nader Kamangar, MD, FACP, FCCP, FAASM,, Associate Professor of Clinical Medicine, Director of Hospitalist/Intensivist Program, Division of Pulmonary, Critical Care and Sleep Medicine, David Geffen School of Medicine at University of California Los Angeles; Associate Director, Combined Pulmonary and Critical Care Fellowship Program, Cedars-Sinai/Olive View-UCLA/West Los Angeles Veterans Affairs Medical Center
Nader Kamangar, MD, FACP, FCCP, FAASM, is a member of the following medical societies: American Academy of Sleep Medicine, American Association of Bronchology, American College of Chest Physicians, American College of Physicians, American Lung Association, American Medical Association, American Thoracic Society, California Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Curtis C Sather, MD, Fellow, Divison of Pulmonary/Critical Care Medicine, Cedars-Sinai Medical Center
Curtis C Sather, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, and American Thoracic Society
Disclosure: Nothing to disclose.

Sat Sharma, MD, FRCPC, Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital
Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Stephen P Peters, MD, PhD, Professor, Department of Medicine, Wake Forest University
Stephen P Peters, MD, PhD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society, and Sigma Xi
Disclosure: See below for list of all activities None None

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

,, Kathy Roarty Placeholder
Disclosure: Nothing to disclose.

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society
Disclosure: Nothing to disclose.

 
 
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