Cavitary Lung Lesion

Dr. Vanderschuur presented an interesting case of a chronic progressive nonproductive cough found to have RUL cavitary parenchymal lung lesion concerning for lung abscess. On bronchoscopy, he was found to have a piece of food lodged in a large airway proximal to the abscess. Some takeaways from Dr. Vanderschuur:

  • Lung abscesses are typically a result of polymicrobial anaerobic infection
  • Immunocompromised individuals also at risk for pseudomonas, other gram negative bacilli, norcardia, TB or fungal
  • Chronic systemic disease symptoms are usually present (weight loss, night sweats and anemia)
  • Imaging usually diagnostic (except in atypical presentations or immunocompromised) and are usually in dependent sections of the lung. Can be helpful for ruling out empyema as well.
  • If atypical presentation or immunosuppressed, will likely need bronchoscopy to rule out more esoteric etiologies
  • There are no standard guidelines for how long to treat lung abscesses, but most recommend serial imaging for resolution and typically will need 4-12 weeks of antibiotics.
  • Patients with clear signs/sxs of lung abscesses can be diagnosed and treated with imaging alone, however, if the presentation is atypical or patient immunosuppressed, will likely need bronchoscopy and rule out of other diagnoses.
  • Procalcitonin can be a useful tool in acute respiratory illnesses to decide on whether to start antibiotics and can help in duration of antibiotic exposure.