The diagnosis and management of lung abscess continues to challenge physicians as more patients present with complex coexisting diseases, often including profound immunosuppression. The diagnosis of a lung abscess is most commonly established by chest radiograph, including both upright and lateral views ( Fig. 60-2). These views typically show an inflammatory infiltrate of the pulmonary parenchyma with one or more cavities containing an air-fluid level.

Analysis of expectorated sputum is an important first step in the evaluation of patients with a lung abscess.11 Sputum should be cultured for aerobic and acid-fast organisms, and fungi. While sputum analysis is not reliable in determining the anaerobic bacteria causing a lung abscess, it is useful in detecting or excluding alternative diagnoses.

Anaerobic bacteria remain the most frequent cause of lung abscess, followed by polymicrobial infections (63 percent with anaerobes as coisolates) and S. aureus. In addition to bacteria, there are several other infectious and noninfectious causes of lung abscess ( Tabl.e... 60-3).

TABLE 60-3 Noninfectious and Infectious Causes of Lung Abscess

Fiberoptic bronchoscopy and/or bronchial alveolar lavage are useful diagnostic adjuncts.

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