Lung abscess: diagnosis and management

Lung abscess is a necrotic cavitary lesion of the lung parenchyma. It is usually secondary to inhalation of anaerobic bacteria or mixed flora. Primary lung abscesses occur in previously healthy patients without underlying comorbidities. They are often solitary. Secondary pulmonary abscesses tend to occur in patients with underlying pathologies and may be multiple. The diagnosis is usually made on chest radiograph showing a lung cavity with a hydro-aerated level. Typically, the lung abscess is surrounded by a thick, irregular wall with a pulmonary infiltrate all around. The dif-ferential diagnoses of pulmonary cavitation are multiple. It may be other types of infections, neoplasia, or bronchial malformations. Management is usually based on prolonged antibiotic treatment. Failure of the initial treatment may result in sepsis or complications requiring percutaneous or endoscopic drainage or surgery.