The Surgical Management of Lung Abscess

¹ The Thoracic Surgery Services of the Georgetown University Medical School.

A series of 247 lung abscesses has been presented, covering a six year period. Of these 188 cases were cured, there being from six months to six years follow-up on most of the patients. Thirty-four patients died (13.7 per cent).

All cases had chemotherapy and bronchoscopy.

The management of lung abscesses depends on the extent of the disease when it is recognized and treatment is begun.

1) In the early formative phase most acute aerobic abscesses can be cured by intensive antibiotic therapy and bronchoscopy. Seventy of the 247 cases presented were treated only in this way.

2) An acute unilocular abscess which does not respond to chemotherapy should have surgical drainage as soon as it is apparent that more conservative measures are inadequate. One hundred nineteen patients in this series had surgical drainage.

3) Multilocular and chronic abscesses need pulmonary resection. Drainage is inadequate in these cases. Pulmonary resection was done in 58 of the present series.

Although the worth of abscess drainage is appreciated, there is a tendency to restrict its use in favor of more prolonged antibiotic conservatism and lobectomy when this fails. As a result most abscesses are complicated and require resection when the surgeon sees them. Of the 39 cases occurring since January 1, 1948 there were only four drainages and 20 resections; two of the resections were on patients previously considered as cured by drainage.

All patients with lung abscess should have a bronchoscopic examination. Unsuspected foreign bodies or bronchial tumors may be discovered by such routine examinations and the thoracic surgeon is introduced to the case early enough to share in the decisions of treatment.