Medical Management of Acute Lung Abscess Report of 12 Cases

¹ The Department of Medicine, Wayne University College of Medicine, and the Veterans Administration Hospital, Dearborn, Michigan.

1) The data in the literature suggest that penicillin therapy has significantly reduced the mortality of acute lung abscess. The present trend of opinion seems to favor combined parenteral and topical administration.

2) Twelve cases of acute lung abscess are reported, of these all but one were considered primary. Eleven responded to parenteral and aerosolized penicillin (in conjunction with amebacides in a single case), and of these radiographic cure resulted in 10. Residual bronchiectasis was demonstrated in but one case. One patient, treated by both medical and surgical measures, died. It was felt that the surgical procedure in no way contributed to the fatal outcome.

3) Whereas It has been emphasized that medical management is not offered in competition to surgical intervention, penicillin therapy would appear to offer an entirely satisfactory means of treating acute uncomplicated lung abscess. Early pneumonotomy is no longer necessary as long as an abscess remains uncomplicated and uninterrupted roentgenographic regression results.

4) Penicillin therapy should be continued until complete healing has been demonstrated by roentgenologic analysis. The latter should include a bronchial mapping in every case, since a significant number of patients with symptomatic cure may have residual bronchopulmonary pathology.

5) Our experience has impressed upon us the need for thoroughly investigating every case of lung abscess for bronchogenic carcinoma, as well as bronchiectasis.