Lung abscess: Multiple choice questions!
A 63 year old woman with COPD presents with a several-week history of fever, night sweats, weight loss, and cough. On CXR, she is noted to have a density in the left upper lobe and a relatively thin-walled cavity. Bronchoscopy and CT scan are suggestive of a lung abscess rather than a malignant process. Which of the following is the most appropriate initial managemnet of this patient?
a. Percutaneous drainage of the lung abscess
b. Systemic antibiotics directed against the causative agent
c. Tube thoracostomy
d. Left upper lobectomy
e. Surgical drainage of the abscess
The answer is b. (Brunicardi, pp. 573-575)
Initial treatment of a lung abscess, once the diagnosis has been made, is systemic antibiotics directed against the causative agent.
The duration of therapy is dependent on the severity of the underlying pneumonia that resulted in the abscess and can last up to 12 weeks.
Often, the abscess drains spontaneously via the tracheobronchial tree, but if it fails to resolve with medical therapy, intervention may be required, ranging from percutaneous to surgical drainage of the abscess or resectional therapy.
pretest surgery p268, 283; question #384 | 
