Welcome to Cross-Canada Paediatric - Respiratory Residency Rounds

Page 7 / Case 01/01


The following is a brief synopsis of the discussion on lung abscess that followed the case presentation:


An abscess is a localized, advanced suppurative infection that affects one or several areas of lung parenchyma.
– primary: no predisposing factors
– secondary: with predisposing factors (see table below under pathogenesis)

Incidence & Prognosis

– decreased incidence since modification of ENT surgical techniques. Once abandoned seated positioning and uncuffed endotracheal tubes, decreased occurrence of post-op lung abscesses.
– decreased mortality from lung abscess after introduction of antibiotics (penicillin)
– mortality rate still remains high: 10 - 38%


Lung abscesses may occur as a result of any of the following :
– oropharyngeal aspiration
– inhalation
– direct inoculation
– contiguous spread
– hematogenous spread

Open TABLE 1 Predisposing factors to lung abscess (children)
Open TABLE 1a Coexistent conditions in lung abscess (adult and children)

Clinical Features

Open TABLE 2 (symptoms)

– dependent lung segments are most often affected. Hence, posterior segments of upper lobes & superior segments of lower lobes.

– Chest Xray or CT chest to confirm. Often do not need sophisticated imaging, but CT chest may show disease prior to Chest Xray. CT also helpful to distinguish abscess from pyopneumothorax.

– low likelihood of malignancy in pediatric population.

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