selected reports Surgical Drainage of Lung Abscess Complicating Acute Community-Acquired Pneumonia* I+ter D. Putgieter; M.B.Ch.B., F.F.A. (S.A.); Hammond, M.B.Ch.B.; Greg Musson , M.B.Ch.B.; and john OdeU, M.B.Ch . B.
Janet M. J
Two cases of severe community-acquired pneumonia requiring IPPV and complicated by the development of lung abscess were successfully treated with early surgical drainage. This procedure may be a life-saving measure in certain instances. (Chest 1991; 99:1280-82) IPPV =intermittent positive pressure ventilation; MSOF =multiple system organ failure
C
ommunity-acquired pneumonia is a common condition, usually running a benign course and responding well to antibiotics, but a small number of patients require hospitalization for more severe infections and a small percentage of these require intensive care f!ianagement for significant respiratory failure . While most of these latter patients respond to intensive care, appropriate antibiotics and supportive management, 17 to 25 percent develop MSOF and die. Early surgical management when consolidation with necrosis and cavitation of the lung occurs may be a life-saving procedure in carefully selected cases. Two cases of community-acquired pneumonia complicated by pulmonary necrosis successfully managed in this way are reported .
radiograph, open drainage of the lung was performed via a minithorawtomy on day 7. The pleural space was fused; about 1 em of lung was incised before entering a cavity from which approximately 150 ml of watery brown pus was drained. A de Pezzar drain was inserted with an underwater drainage system . Culture of the pus was negative for bacteria; histologic study showed acute pulmonary inOammation and necrosis. Following surgery, the patient's t'ratively. dropped to 1.31t.•t·tts were cnltnred from tht• pns and also from a throat swah; tlwn• was 110 pr e t·c•din~ot history of aspiration.
Followinlo( the tlumll"tomy, profnse pns was drained and the patient rapidly improved . llis ~otc•neral mmlition improved with pyrexia and hypoxia. and tlw ahnormalitit's t'vident·ed on the chest radiof.(raph wen• resolvinJ,t. Tlw patit•nt was dischar~oted from the ICU ten days latt•r.
F1c:u11E 3. Admission chest radioJ,traph showinf.( hilateralloss ofltmf.( volume with left lower zone opacification and dilated loops ofhowel.
DISCl lSSION
Lung abscess is recognized as a rare complication of community-acquired pneumonia, st•c•n commonly in the alcoholic and occasionally in immunot·omJ>etl'nt patients. Pneumonia complicatd by ahscss formation has a high mortality. Although many patients respond to antibiotics, surgical tratment using pnt>umonotomy and opt>n drainage has heen re
Janet M. J
Two cases of severe community-acquired pneumonia requiring IPPV and complicated by the development of lung abscess were successfully treated with early surgical drainage. This procedure may be a life-saving measure in certain instances. (Chest 1991; 99:1280-82) IPPV =intermittent positive pressure ventilation; MSOF =multiple system organ failure
C
ommunity-acquired pneumonia is a common condition, usually running a benign course and responding well to antibiotics, but a small number of patients require hospitalization for more severe infections and a small percentage of these require intensive care f!ianagement for significant respiratory failure . While most of these latter patients respond to intensive care, appropriate antibiotics and supportive management, 17 to 25 percent develop MSOF and die. Early surgical management when consolidation with necrosis and cavitation of the lung occurs may be a life-saving procedure in carefully selected cases. Two cases of community-acquired pneumonia complicated by pulmonary necrosis successfully managed in this way are reported .
radiograph, open drainage of the lung was performed via a minithorawtomy on day 7. The pleural space was fused; about 1 em of lung was incised before entering a cavity from which approximately 150 ml of watery brown pus was drained. A de Pezzar drain was inserted with an underwater drainage system . Culture of the pus was negative for bacteria; histologic study showed acute pulmonary inOammation and necrosis. Following surgery, the patient's t'ratively. dropped to 1.31t.•t·tts were cnltnred from tht• pns and also from a throat swah; tlwn• was 110 pr e t·c•din~ot history of aspiration.
Followinlo( the tlumll"tomy, profnse pns was drained and the patient rapidly improved . llis ~otc•neral mmlition improved with pyrexia and hypoxia. and tlw ahnormalitit's t'vident·ed on the chest radiof.(raph wen• resolvinJ,t. Tlw patit•nt was dischar~oted from the ICU ten days latt•r.
F1c:u11E 3. Admission chest radioJ,traph showinf.( hilateralloss ofltmf.( volume with left lower zone opacification and dilated loops ofhowel.
DISCl lSSION
Lung abscess is recognized as a rare complication of community-acquired pneumonia, st•c•n commonly in the alcoholic and occasionally in immunot·omJ>etl'nt patients. Pneumonia complicatd by ahscss formation has a high mortality. Although many patients respond to antibiotics, surgical tratment using pnt>umonotomy and opt>n drainage has heen re
