Pulmonary abscess are localized are localized areas composed of thick walled purulent material formed as a result of lung

infection that lead to destructionof lung parenchyma, cavitation, and central necrosis Primary no underlying medical disorders Secondary in a patient with underlying or predisposing conditions

Predisposing condition
Aspiration Pneumonia Cystic fibrosis
Gastroesofageal reflux
Tracheoesophageal fistula

Seizures
A variety of neurologic diseases

Aspiration of infected materials or a foreign body is the predominant source of the organisms causing abscess Initially, a pneumonitis impairs drainage of fluid or the aspirated materials Inflammatory vascular obtruction occurs, leading to tissue necrosis, liquefaction, and abscess formation

aerobic bacteria

Streptococcus spp Staphylococcus aureus Klebsiella pneumonia Pseudomonas aeruginosa Escherechia coli

Bacteroides spp Anerobic Fusobacterium spp organisms Peptostreptoccus spp

All patients with a lung abscess should have aerobic and anaerobic cultures as part of their work-up

Fungi can also cause lung abscess, particularly in immunocompromised patients

The most common symptoms of pulmonary abscess in the pediatric population include cough, fever, tachypnea, dyspnea, chest pain, vomiting, sputum production, weight loss and hemoptysis. Physical examination typically reveals tachypnea, dyspnea, retractions, decreased breath sounds, and dullness to percussion in the affected area. Crackles and, occasionally, a prolonged expiratory phase may be heard on lung examination.

Diagnosis is most commonly made on chest radiography. Clasically, the cest radiograph shows a parenchymal inflammation a cavity containing an air fluid level. A chest CT scan can provide better anatomic definition, including location & size

Conservative management is recommended More axperts advocate a 2-3 wk course of parenteral antibiotics for uncomplicated cases, followed by oral antiboitics to complete a total 4-6 wk. Antibiotic choice should be guided by gram stain culture but initially should include aerobic and anaerobic coverage. Treatment regimens should include a penicillin resistant agent active against S. aureus & anaerobic coverage, typically with clindamycin or ticarcillin/clavulinic acid.

If gram negatif bacteria are suspected or isolated, an aminoglycoside should be added For severally ill patients or who fail to improve after 7-10 days of AB, surgical intervention should be consideredminimally invasive percutaneus aspiration techniques with CT guidance.

Overall, prognosis for children with primary pulmonary abscess is excellent Most children become asymptomatic within 7-10 days, although the fever can persist for as long as 3 wk. Radiologic abnormalities usually resolve in13 mo but can persist for years