Lung abscess can be divided on acute (less than 6 weeks) and chronic (more than 6 weeks). In pre antibiotic era, lung abscess was caused by one type of bacteria, and today almost in all cases is caused by poly microbial flora ( 2). Today, aspiration from oral cavity is considered the major cause of lung abscesses as well as poor oral and dental hygiene ( 6). At the same time, progress in oral and dental hygiene declined the incidence of lung abscesses.
Open drainage of lung abscess decreased mortality on 20-35% and with antibiotic therapy mortality drop on about 8.7% ( 5). Hundred years ago, mortality from lung abscess was about 75% of patients ( 4). In that time, surgery was considered as the only effective therapy, and today most of the patients will be fully recovered only with antibiotic therapy. In pre-antibiotic era, one third of patients with lung abscess would die, the other third of patients would recover fully, and the rest of them would survive with sequels such as chronic lung abscess, pleural empyema or bronchiectasis ( 3). The clinical signs and therapy of lung abscess was described for the first time by Hippocrates. Lung abscess is in the group of lung infections such as lung gangrene and necrotizing pneumonia which is characterized with multiple abscesses ( 2). Lung abscess is defined as a circumscribed area of pus or necrotic debris in lung parenchima, which leads to a cavity, and after formation of bronchopulmonary fistula, an air-fluid level inside the cavity ( 1). In the current review we will present all current information from diagnosis to treatment. Surgical procedures are required in selective patients for drainage or pulmonary resection.
Pulmonary physiotherapy and postural drainage are also important. Broad spectrum antibiotic to cover mixed flora is the mainstay of treatment. There are several imaging techniques which can identify the material inside the thorax such as computerized tomography (CT) scan of the thorax and ultrasound of the thorax. Lung abscess is considered primary (60%) when it results from existing lung parenchymal process and is termed secondary when it complicates another process, e.g., vascular emboli or follows rupture of extrapulmonary abscess into lung. Moreover, alcoholism is the most common condition predisposing to lung abscesses. It can be caused by aspiration, which may occur during altered consciousness and it usually causes a pus-filled cavity. Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial infection.
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