CRA11 "BATTLE IN THE THORAX, WHEN INFECTION DOESN’T QUIT"- A CASE SERIES OF MASSIVE LUNG ABSCESS

Wai Leong Liew¹, Yoke Fong Lam^1
1Hospital Raja Permaisuri Bainun, Ipoh

Introduction
Lung abscesses are localized collections of pus in the lung parenchyma, typically presenting with fever (80%), cough (55%-90%), pleuritic chest pain (20-35%), hemoptysis (10%), and dyspnea (10%).

Objective
To highlight diverse clinical presentations and management strategies of two massive lung abscess patients.

Methodology: Case Series

Case 1
A 40-year-old female presented with recurrent hemoptysis for 1day. No fever, white blood cell count (WBC) 9.3 10^9/L, c-reactive protein (CRP) 12.4 mg/L & CT Thorax revealed right lower lobe abscess (9.1 x 9.1 x 7.4 cm). Bronchoscopy showed whitish nodules along trachea, upper part of right main bronchus and blood-stained secretion right lower lobe of lung. Antibiotics and antifungal were initiated with nebulized tranexamic acid. Due to massive hemoptysis with drop in HB (HB 11.5g/dL to 7.4 g/dL), she underwent right middle and lower lobectomy. Postoperatively, she was weaned to room air by day 5. Tissue cultured Staphylococcus aureus sensitive to oxacillin. Follow-up showed full clinical recovery.

Case 2
A 56-year-old female with poorly control diabetes mellitus, presented with 2 weeks fever, cough and progressive dyspnea. WBC 20.4 10^9/L, CRP 173 mg/L & CT-Thorax showed left lung abscess (11.2 x 11.1 x 7.5 cm). Antibiotic therapy was initiated, however oxygen demand increased to high flow nasal cannula, (fio2 50%/50L). Patient had percutaneous catheter drainage which drained 1.1L of pus. Patient was weaned to room air by day8. No organisms were cultured from pus & blood.

Results & Conclusion
Antibiotics remain first-line of treatment. In large abscesses (>6cm), percutaneous drainage/ surgical intervention should be considered. Success rate percutaneous drainage (86.5%) and survival rate of lung resection (89-95%) for appropriately selected patient.