Percutaneous lung abscess drainage: revisiting the old gold standard

Abstract

Lung abscess is defined as the necrosis of lung tissue with cavity formation due to varied etiology. The treatment of lung abscesses is medical involving antibiotics and chest physiotherapy. The failure of medical line of management requires an invasive surgical or percutaneous approach for drainage and control of infection. While the literature is ample regarding the surgical approach, it is rather scarce on the percutaneous approach. The percutaneous drainage has been most studied with computed tomography guidance. With our case series we describe to the treatment of lung abscesses non-responsive to medical management, by a bedside minimally invasive ultrasound or fluoroscopy guided percutaneous drainage approach.

A Large Lung Abscess in an Electronic Cigarette User: To Drain or Not to Drain

“…However, with the advent of potent antibiotics, lung abscesses respond to medical therapy in 80%-90% of cases. A review of the literature showed acceptable outcomes for percutaneous drainage of lung abscesses not responding to medical treatment, with some studies reporting up to 80%-100% success rate [ 4 - 6 ]. This is especially useful in patients who have a significant morbidity and mortality risk for surgery.…”

“…In lung abscesses measuring 6-8 cm, not responding to initial antibiotic therapy, percutaneous drainage is recommended. The complication rate for percutaneous abscess drainage has been reported to be around 8% to 16%, with a mortality rate of around 4% [ 4 - 6 ]. Complications include catheter blockage necessitating repeat procedures, pneumothorax, hemothorax, hemoptysis and need for surgical intervention.…”

“…One of the most feared complications is infection of the pleural space and resultant bronchopleural fistula. There have been reports with as high as 8% incidence of bronchopleural fistula cases of lung abscesses treated with percutaneous drainage [ 4 - 6 ]. In recalcitrant cases, surgical resection is considered, although it is associated with a mortality risk of up to 20%.…”

Lung abscess: the non-conservative management: a narrative review

“…Matarese et al ( 4 ) used 14 G needle to aspirate lung abscesses under ultrasound guidance in a series of eight patients. They used a 14 G needle because no pigtail catheters were available at the hospital.…”

“…Moreover, any abscess greater than 6 cm in diameter is less likely to respond to antibiotics and frequently requires additional drainage procedures ( 2 , 3 ). There is a higher likelihood of treatment failure when treated with antibiotics alone in immunocompromised patients, abscess with underlying malignancy, advanced age, decreased level of consciousness, or infection with certain organisms, such as Klebsiella pneumoniae , Pseudomonas aeruginosa , and Staphylococcus aureus ( 4 ). Despite systemic antibiotic treatment, persistent clinical symptoms, or presence of radiologic evidence of active abscess, warrant a more definitive therapy with invasive procedures and, ultimately surgery.…”