Differential Diagnoses

Actinomycosis
Alcoholism
Aspiration Pneumonitis and Pneumonia
Bacterial Pneumonia
Cavitating lung cancer
Cavitating lung infarcts
Cavitating pneumoconiosis
Cavitating sarcoidosis
Fungal Pneumonia
Granulomatosis with Polyangiitis (GPA, formerly Wegener Granulomatosis)

And other vasculitides.
Hiatus hernia
Hydatid Cysts
Infected bulla containing a fluid level
Infected congenital pulmonary lesion, such as bronchogenic cyst or sequestration
Infective Endocarditis
Localized empyema
Lung parasites (eg, hydatid cyst, Paragonimus infection)
Mycetoma
Mycobacterium Avium Complex (MAC) (Mycobacterium Avium-Intracellulare [MAI])
Mycobacterium Chelonae
Mycobacterium Kansasii
Nocardiosis
Non-Small Cell Lung Cancer (NSCLC)
Parapneumonic Pleural Effusions and Empyema Thoracis
Pneumococcal Infections (Streptococcus pneumoniae)
Pneumocystis jiroveci Pneumonia (PJP)
Pulmonary Embolism (PE)
Pulmonary hematoma
Sarcoidosis
Septic Thrombophlebitis
Small Cell Lung Cancer (SCLC)
Tuberculosis (TB)

Workup

Bartlett JG, Finegold SM. Anaerobic infections of the lung and pleural space. Am Rev Respir Dis. 1974 Jul. 110(1):56-77. [Medline].
Wang JL, Chen KY, Fang CT, Hsueh PR, Yang PC, Chang SC. Changing bacteriology of adult community-acquired lung abscess in Taiwan: Klebsiella pneumoniae versus anaerobes. Clin Infect Dis. 2005 Apr 1. 40(7):915-22. [Medline].
Takayanagi N, Kagiyama N, Ishiguro T, Tokunaga D, Sugita Y. Etiology and outcome of community-acquired lung abscess. Respiration. 2010. 80(2):98-105. [Medline].
Moreira Jda S, Camargo Jde J, Felicetti JC, Goldenfun PR, Moreira AL, Porto Nda S. Lung abscess: analysis of 252 consecutive cases diagnosed between 1968 and 2004. J Bras Pneumol. 2006 Mar-Apr. 32(2):136-43. [Medline].
Mwandumba HC, Beeching NJ. Pyogenic lung infections: factors for predicting clinical outcome of lung abscess and thoracic empyema. Curr Opin Pulm Med. 2000 May. 6(3):234-9. [Medline].
Pohlson EC, McNamara JJ, Char C, Kurata L. Lung abscess: a changing pattern of the disease. Am J Surg. 1985 Jul. 150(1):97-101. [Medline].
Hirshberg B, Sklair-Levi M, Nir-Paz R, Ben-Sira L, Krivoruk V, Kramer MR. Factors predicting mortality of patients with lung abscess. Chest. 1999 Mar. 115(3):746-50. [Medline].
Stark DD, Federle MP, Goodman PC, Podrasky AE, Webb WR. Differentiating lung abscess and empyema: radiography and computed tomography. AJR Am J Roentgenol. 1983 Jul. 141(1):163-7. [Medline].
Williford ME, Godwin JD. Computed tomography of lung abscess and empyema. Radiol Clin North Am. 1983 Sep. 21(3):575-83. [Medline].
Bouhemad B, Zhang M, Lu Q, Rouby JJ. Clinical review: Bedside lung ultrasound in critical care practice. Crit Care. 2007. 11(1):205. [Medline].
Bartlett JG. Anaerobic bacterial infections of the lung. Chest. 1987 Jun. 91(6):901-9. [Medline].
Sosenko A, Glassroth J. Fiberoptic bronchoscopy in the evaluation of lung abscesses. Chest. 1985 Apr. 87(4):489-94. [Medline].
Appelbaum PC, Spangler SK, Jacobs MR. Beta-lactamase production and susceptibilities to amoxicillin, amoxicillin-clavulanate, ticarcillin, ticarcillin-clavulanate, cefoxitin, imipenem, and metronidazole of 320 non-Bacteroides fragilis Bacteroides isolates and 129 fusobacteria from 28 U.S. centers. Antimicrob Agents Chemother. 1990 Aug. 34(8):1546-50. [Medline].
Perlino CA. Metronidazole vs clindamycin treatment of anerobic pulmonary infection. Failure of metronidazole therapy. Arch Intern Med. 1981 Oct. 141(11):1424-7. [Medline].
Sanders CV, Hanna BJ, Lewis AC. Metronidazole in the treatment of anaerobic infections. Am Rev Respir Dis. 1979 Aug. 120(2):337-43. [Medline].
Richter SS, Heilmann KP, Dohrn CL, Riahi F, Costello AJ, Kroeger JS, et al. Activity of ceftaroline and epidemiologic trends in Staphylococcus aureus isolates collected from 43 medical centers in the United States in 2009. Antimicrob Agents Chemother. 2011 Sep. 55(9):4154-60. [Medline]. [Full Text].
Wunderink RG, Niederman MS, Kollef MH, Shorr AF, Kunkel MJ, Baruch A, et al. Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study. Clin Infect Dis. 2012 Mar 1. 54(5):621-9. [Medline].
Allewelt M, Schuler P, Bolcskei PL, Mauch H, Lode H. Ampicillin + sulbactam vs clindamycin +/- cephalosporin for the treatment of aspiration pneumonia and primary lung abscess. Clin Microbiol Infect. 2004 Feb. 10(2):163-70. [Medline].
Ott SR, Allewelt M, Lorenz J, Reimnitz P, Lode H. Moxifloxacin vs ampicillin/sulbactam in aspiration pneumonia and primary lung abscess. Infection. 2008 Feb. 36(1):23-30. [Medline].
Macfarlane DJ, Tucker LG, Kemp RJ. Treatment of recalcitrant actinomycosis with ciprofloxacin. J Infect. 1993 Sep. 27(2):177-80. [Medline].
Ferreira D, de F, Amado J, Neves S, Taveira N, Carvalho A, et al. Treatment of pulmonary actinomycosis with levofloxacin. J Bras Pneumol. 2008 Apr. 34(4):245-8. [Medline].
Lerner PI. Nocardiosis. Clin Infect Dis. 1996 Jun. 22(6):891-903; quiz 904-5. [Medline].
Clark NM. Nocardia in solid organ transplant recipients. Am J Transplant. 2009 Dec. 9 Suppl 4:S70-7. [Medline].
Sorrell TC, Mitchell DH, Iredell JR. Nocardia species. Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Disease. 6th edition. Philadelphia: Elsevier; 2005. 2916.
Herth F, Ernst A, Becker HD. Endoscopic drainage of lung abscesses: technique and outcome. Chest. 2005 Apr. 127(4):1378-81. [Medline].
Kelogrigoris M, Tsagouli P, Stathopoulos K, Tsagaridou I, Thanos L. CT-guided percutaneous drainage of lung abscesses: review of 40 cases. JBR-BTR. 2011 Jul-Aug. 94(4):191-5. [Medline].
Taniguchi M, Morita S, Ueno E, Hayashi M, Ishikawa M, Mae M. Percutaneous transhepatic drainage of lung abscess through a diaphragmatic fistula caused by a penetrating liver abscess. Jpn J Radiol. 2011 Nov. 29(9):663-6. [Medline].

Media Gallery

Histology of a lung abscess shows dense inflammatory reaction (low power).
A thick-walled lung abscess.
Pneumococcal pneumonia complicated by lung necrosis and abscess formation.
A lateral chest radiograph shows air-fluid level characteristic of lung abscess.
A 54-year-old patient developed cough with foul-smelling sputum production. A chest radiograph shows lung abscess in the left lower lobe, superior segment.
A 42-year-old man developed fever and production of foul-smelling sputum. He had a history of heavy alcohol use, and poor dentition was obvious on physical examination. Chest radiograph shows lung abscess in the posterior segment of the right upper lobe.
A 42-year-old man developed fever and production of foul-smelling sputum. He had a history of heavy alcohol use, and poor dentition was obvious on physical examination. Lung abscess in the posterior segment of the right upper lobe was demonstrated on chest radiograph. CT scan shows a thick-walled cavity with surrounding consolidation.
Chest radiograph of a patient who had foul-smelling and bad-tasting sputum, an almost diagnostic feature of anaerobic lung abscess.
Histology of a lung abscess shows dense inflammatory reaction (high power).

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Author

Nader Kamangar, MD, FACP, FCCP, FCCM Professor of Clinical Medicine, University of California, Los Angeles, David Geffen School of Medicine; Chief, Division of Pulmonary and Critical Care Medicine, Vice-Chair, Department of Medicine, Olive View-UCLA Medical Center

Nader Kamangar, MD, FACP, FCCP, FCCM is a member of the following medical societies: Academy of Persian Physicians, American Academy of Sleep Medicine, American Association for Bronchology and Interventional Pulmonology, American College of Chest Physicians, American College of Critical Care Medicine, American College of Physicians, American Lung Association, American Medical Association, American Thoracic Society, Association of Pulmonary and Critical Care Medicine Program Directors, Association of Specialty Professors, California Sleep Society, California Thoracic Society, Clerkship Directors in Internal Medicine, Society of Critical Care Medicine, Trudeau Society of Los Angeles, World Association for Bronchology and Interventional Pulmonology

Disclosure: Nothing to disclose.

Coauthor(s)

Jason E Bahk, MD Resident Physician, Department of Internal Medicine, Olive View-UCLA Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Guy W Soo Hoo, MD, MPH Clinical Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Director, Medical Intensive Care Unit, Pulmonary and Critical Care Section, West Los Angeles Healthcare Center, Veteran Affairs Greater Los Angeles Healthcare System

Guy W Soo Hoo, MD, MPH is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Thoracic Society, Society of Critical Care Medicine, California Thoracic Society, American Association for Respiratory Care

Disclosure: Nothing to disclose.

Additional Contributors

Stephen P Peters, MD, PhD, FACP, FAAAAI, FCCP, FCPP Thomas H Davis Chair in Pulmonary Medicine, Chief, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Professor of Internal Medicine, Pediatrics, and Translational Science, Associate Director, Center for Genomics and Personalized Medicine Research, Wake Forest University School of Medicine; Executive Director of the Respiratory Service Line, Wake Forest Baptist Medical Center

Stephen P Peters, MD, PhD, FACP, FAAAAI, FCCP, FCPP 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, Sigma Xi, The Scientific Research Honor Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Integrity CE, Merck<br/>Received income in an amount equal to or greater than $250 from: – Array Biopharma, AstraZeneca, Aerocrine, Airsonett AB, Boehringer-Ingelheim, Experts in Asthma, Gilead, GlaxoSmithKline, Merck, Novartis, Ono Pharmaceuticals, Pfizer, PPD Development, Quintiles, Sunovion, Saatchi & Saatichi, Targacept, TEVA, Theron.

Acknowledgements

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.

Lung Abscess Differential Diagnoses

Differential Diagnoses

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