Primary lung abscess

Multiple factors have played a role in the sharp decline of the incidence of lung abscess in the last several decades. Notable among these are the introduction of antibiotics, improvements in anesthesia, advances in head and neck surgery, and, finally, our better understanding and knowledge of the role of oral-dental hygiene and alcoholism in the development of lung abscess. The most recent 5 year experience of lung abscess from our own institution revealed an average incidence of 11 cases per year. The main predisposing factor continues to be alteration of the patient's state of consciousness (80/107). This may be secondary to seizure disorders, cerebrovascular accidents, general anesthesia, and, most commonly, alcoholism (55/107). All of these conditions, in conjunction with the specific anatomic segmental localization, strongly favor aspiration as the common denominator in the development of lung abscess in the overwhelming majority of cases. Bacteriologic examination confirms the important role of anaerobes in lung abscess development. Its role is further supported by the presence of severe gingivodental disease in the majority of cases. This relationship was also confirmed in our experience, where almost 60% (64/107) presented with severe gingivodental disease. Proper 'medical' management may provide cure in many patients with lung abscess; however, in some patients surgical intervention will be necessary and lobectomy is the preferred surgical procedure. The role of external drainage is extremely limited and probably should be avoided.