How is it Diagnosed?
A lung abscess is a localized collection of pus within the lung parenchyma, usually
resulting from infection. Diagnosis begins with a detailed clinical history focusing on
symptoms like fever, productive cough with foul-smelling sputum, chest pain, and
weight loss. Risk factors such as aspiration (in unconscious or alcoholic patients), poor
dental hygiene, or immunosuppression are also considered.
Physical examination may reveal signs of pulmonary consolidation, such as dullness to
percussion and decreased breath sounds. A chest X-ray is the initial imaging modality
and typically shows a cavitary lesion with an air-fluid level. Computed Tomography (CT)
of the chest provides better detail, helping to distinguish lung abscesses from other
cavitary lung lesions like malignancy or tuberculosis.
Sputum analysis is done for Gram staining, culture, and sensitivity to identify causative
organisms, especially anaerobes. Blood cultures may be useful if systemic infection is
suspected. Bronchoscopy may be warranted to exclude obstruction due to malignancy
or a foreign body and to obtain samples for microbiological analysis.
In select cases, needle aspiration or drainage under imaging guidance may be
necessary for both diagnosis and therapeutic purposes. Accurate diagnosis is crucial,
as treatment with appropriate antibiotics can often prevent surgical intervention.