Nader Kamangar, MD, FACP, FCCP FCCM, FAASM, Associate Professor of Clinical Medicine, University

Nader Kamangar, MD, FACP, FCCP FCCM, FAASM, Associate Professor of Clinical Medicine, University
of California, Los Angeles, David Geffen School of Medicine; Chief, Division of Pulmonary and Critical Care
Medicine, Olive View-UCLA Medical Center; Associate Program Director, Multi-Campus Pulmonary and
Critical Care Fellowship Program, Cedars-Sinai/West Los Angeles Veterans Affairs/Los Angeles Kaiser
Permanente/Olive View-UCLA Medical Center
Imaging Studies
Imaging studies include the following:
Chest radiography
[8]
A typical chest radiographic appearance of a lung abscess is an

irregularly shaped cavity with an air-fluid level. Lung abscesses as a
result of aspiration most frequently occur in the posterior segments
of the upper lobes or the superior segments of the lower lobes.
The wall thickness of a lung abscess progresses from thick to thin

and from ill-defined to well-circumscribed as the surrounding lung
infection resolves. The cavity wall can be smooth or ragged but is
less commonly nodular, which raises the possibility of cavitating
carcinoma.
The extent of the air-fluid level within a lung abscess is often the
same in posteroanterior or lateral views. The abscess may extend to
the pleural surface, in which case it forms acute angles with the
pleural surface.
Anaerobic infection may be suggested by cavitation within a dense

segmental consolidation in the dependent lung zones.
Lung infection with a virulent organism results in more widespread

tissue necrosis, which facilitates progression of underlying infection
to pulmonary gangrene.
Up to one third of lung abscesses may be accompanied by an

empyema. See the images below.
Pneumococcal
pneumonia complicated by lung necrosis and abscess formation.
A lateral chest
radiograph shows air-fluid level characteristic of lung abscess.
A 54-year-old
patient developed cough with foul-smelling sputum production. A
chest radiograph shows lung abscess in the left lower lobe, superior
segment.
A 42-year-old
man developed fever and production of foul-smelling sputum. He
had a history of heavy alcohol use, and poor dentition was obvious
on physical examination. Chest radiograph shows lung abscess in
the posterior segment of the right upper lobe.
Chest radiograph of
a patient who had foul-smelling and bad-tasting sputum, an almost
diagnostic feature of anaerobic lung abscess.
Computed tomography
[8, 9]
CT scanning of the lungs may help visualize the anatomy better

than chest radiography. CT scanning is very useful in the
identification of concomitant empyema or lung infarction.
On CT scans, an abscess often is a rounded radiolucent lesion with a

thick wall and ill-defined irregular margins.
The vessels and bronchi are not displaced by the lesion, as they are
by an empyema.
The lung abscess is located within the parenchyma compared with

loculated empyema, which may be difficult to distinguish on chest
radiographs.
The abscess forms acute angles with the pleural surface chest wall.
See the image below.
A 42-year-old
man developed fever and production of foul-smelling sputum. He
had a history of heavy alcohol use, and poor dentition was obvious
on physical examination. Lung abscess in the posterior segment of
the right upper lobe was demonstrated on chest radiograph. CT
scan shows a thin-walled cavity with surrounding consolidation.
o
Repeat chest radiographs may be obtained after treatment to

determine response to antimicrobial therapy.
Ultrasonography
o
Peripheral lung abscesses with pleural contact or included inside a

lung consolidation are detectable using lung ultrasonography at the
bedside.
Lung abscess appears as a rounded hypoechoic lesion with an outer

margin.
If a cavity is present, additional nondependent hyperechoic signs

are generated by the gas-tissue interface. [10]
LUNG ABSCESS
Suppuration and necrosis of pulmonary tissue may he due to tuberculosis,
fungal infection, malignant tumour and infected cysts.
However, the term lung abscess usually refers to a cavitating lesion
secondary to infection by pyogenic bacteria. This is most frequently
due to aspiration of infected material from the upper respiratory
tract, and is often associated with poor dentition and periodontal
i nfection (Fig. 5.1 K). A variety of organisms may be responsible,
and anaerobic bacteria are frequently found in the sputum. Occasionally
there is a history of loss of consciousness and presumed
aspiration. Other causes of lung abscess include staphylococcal
( Fig. 5.19) and Klebsiella pneumonia, septic pulmonary emboli
( Fig. 5.3) and trauma.
Radiographically an abscess may or may not be surrounded by
consolidation. Appearance of an air-fluid level indicates that a communication
with the airways has developed. The wall of the abscess
may be thick at first, but with further necrosis and coughing up of infected material it becomes thinner
Supurasi dan nekrosis dari jaringan pulmonal bisa disebabkan oleh

tuberculosis, infeksi jamur, tumor maligna dan infeksi kista. Tetapi masa
dari abses paru biasanya menunjukkan sebuah lesi cavitas dari infeksi
sekunder oleh bakteri pyogenic. Ini paling sering disebabkan oleh aspirasi
dari benda infeksius dari sistem pernafasan atas. Dan sering berkaitan
dengan pertumbuhan gigi yang kurang dan infeksi gigi periodontal.
Beragam organisme bisa ikut berperan dan bakteri anaerob sering juga
ditemukan dalam sputum. Kadang-kadang ada riwayat kehilangan
kesadaran dan diduga aspirasi. Penyebab abses paru lainnya termasuk
Staphylococcal dan Klabsiella pneumoni, septic pulmonary emboli dan
trauma.
Secara radiologi sebuah abses bisa atau tidak dikelilingi oleh
konsolidasi. Gambaran dari air fluid level menunjukkan ada hubungan
dengan jlur udara yang terbentuk. Awalnya dinding abses tebal tapi
dengan nekrosis selanjutnya dan batuk mengangkat material infeksi
menjadi lebih tipis.
5.18 (A) Lung abscess. There was poor dental hygiene. Mixed anaerobic growth. (B) Several weeks later a thin-walled
pneumatocele remains.
Sutton and David, A Textbook of Radiology and Imaging Edisi 7 Vol. I.

London: Churchill living stone,.138-139,

Nader Kamangar, MD, FACP, FCCP FCCM, FAASM, Associate Professor of Clinical Medicine, University

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Nader Kamangar, MD, FACP, FCCP FCCM, FAASM, Associate Professor of Clinical Medicine, University

A typical chest radiographic appearance of a lung abscess is an

The wall thickness of a lung abscess progresses from thick to thin

Anaerobic infection may be suggested by cavitation within a dense

Lung infection with a virulent organism results in more widespread

Up to one third of lung abscesses may be accompanied by an

CT scanning of the lungs may help visualize the anatomy better

On CT scans, an abscess often is a rounded radiolucent lesion with a

The lung abscess is located within the parenchyma compared with

Repeat chest radiographs may be obtained after treatment to

Peripheral lung abscesses with pleural contact or included inside a

Lung abscess appears as a rounded hypoechoic lesion with an outer

If a cavity is present, additional nondependent hyperechoic signs

Supurasi dan nekrosis dari jaringan pulmonal bisa disebabkan oleh

Sutton and David, A Textbook of Radiology and Imaging Edisi 7 Vol. I.

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