Lung abscess

Diagnosis: The lung abscess from the aspiration — the alcohol misuse and the poor dentition (the risk factors), the foul-smelling sputum (the anaerobes), the weight loss (the chronic), and the cavity with the air-fluid level, typically thick and irregular walled with surrounding infiltrate.^[3]

Assessment: ABCDE. The chest CT (the cavity with the air-fluid level, the size, the surrounding infiltrate). Lower respiratory tract sampling to define the pathogens; blood cultures before antibiotics.^[3]

Management:

1. The anaerobic cover — clindamycin has the randomised edge over penicillin for the putrid abscess; match broadening to the scenario.
2. The duration — prolonged treatment as trialled (3 or 6 weeks), with clinical and radiological monitoring.
3. The percutaneous or endoscopic drainage if conservative management fails — persistence of sepsis or other complications.
4. The surgery (open removal) for failure in patients with good performance status and sufficient respiratory reserve.
5. The treat-the-underlying — the alcohol, the dentition, the aspiration risks.
6. The complications — secondary infection, airway obstruction, empyema, bronchopleural fistula.

The disposition: The admission for the intravenous antibiotics and the monitoring, the prolonged course, the follow-up imaging to the resolution.^[3]