Diagnosis

The diagnosis of a lung abscess can often be made on the basis of the clinical picture. X-rays of the lungs are then used to prove the diagnosis. A computer tomography then shows the exact course of the abscess cavity.

The blood count shows an increase in inflammation values, such as CRP, leukocytes and infectious anemia. In the case of already tunneled lung abscesses, a bronchoscopy can show the abscess duct. A lung abscess can develop as a result of a bacterial infection, for example in pneumonia.

The pathogen is detected by examination of a blood sample or by diagnostics of the sputum (sputum). Typical pathogens that cause a lung abscess in pneumonia are pneumococci, streptococci, Pseudomonas, Legionella or Klebsiello. Lung abscesses can also be caused by bacteria from the mouth and throat area that have been inhaled with the pharyngeal secretion and have multiplied in the lungs.

These pathogens are usually anaerobic bacteria that do not require oxygen to grow, such as Becteroides, Peptostreptococci or Fusobacterium. Mixed infections with aerobic and anaerobic bacteria as well as an additional infestation with fungi or worms are also possible with a lung abscess. For diagnosis and confirmation of the findings, a CT image of the lung can be taken as an alternative to an X-ray thorax. A CT scan can provide a precise image of the lung tissue and exclude other diseases that also manifest themselves as round foci in the lung (e.g. tuberculosis or bronchial carcinoma).

Therapy

The conservative treatment of pulmonary abscesses consists of antibiotic treatment and repeated bronchoscopic aspiration of the pus. A so-called vibration massage can also lead to accelerated dissolving of the secretion. In case of failure of conservative therapy, surgical therapy must be used in most cases, which consists of surgical opening of the abscess cavity and subsequent removal or suction.A wound drainage is then inserted and the abscess cavity is regularly rinsed.

Very large abscesses or chronic abscesses usually have to be removed completely by surgery, which often means the removal of a whole section of the lung. The treatment of a lung abscess is done by means of antibiotic therapy. For this it is necessary to determine the pathogen by microbiological examination of the blood or sputum (sputum).

The antibiotics are chosen to cover a broad spectrum of activity and the treatment is effective against both aerobic bacteria (bacteria that require oxygen) and anaerobic bacteria (bacteria that can live without oxygen). In most cases of pulmonary abscesses, clindamycin is administered in combination with cefotaxime or ciprofloxacin. Depending on the degree of severity, so-called beta-lactam antibiotics such as ampicillin, piperacillin or amoxicillin can also be used to combat the pathogens.

The antibiotic therapy is administered in the first few days by infusion and then in the form of tablets. The entire treatment with antibiotics takes several weeks until the abscess has completely receded. A lung abscess is usually treated non-surgically, i.e. conservatively.

Here antibiotics are used. In addition, a bronchoscopy is often performed, in which the abscess cavity is emptied and a cytological sample is usually taken to rule out a malignant process. Usually these two measures are sufficient to heal a lung abscess, even if the healing process sometimes takes a long time.

In rare cases, however, it can happen that a lung abscess cannot be healed under antibiotic and bronchoscopic therapy. In this case, the operation in which the part of the lung in which the abscess is located must be removed is considered the last resort. As little lung tissue as possible is removed. Rarely, due to the size or location of the abscess, a whole lobe of the lung has to be resected.