CONCEALED LUNG ABSCESS IN CRITICALLY ILL, MECHANICALLY VENTILATED PATIENTS

We describe 3 critically ill patients with pneumonia complicated by lu ng abscesses and contralateral pneumonia due to spill of purulent secr etions into the healthy lung. Although the clinical picture of lung ab scess often runs an indolent course, this was not observed in these cr itically ill patients, who all died from this complication. Diagnosis was delayed as chest X-ray underestimated lung pathology compared to c omputed tomography (CT) scan. Therefore percutaneous chest tube draina ge and placement of a double-lumen endobronchial tube to protect the h ealthy lung were delayed and spill of purulent secretions into the con tralateral lung occurred. These cases show the importance of rapid eva luation by CT scan of the chest in mechanically ventilated patients wi th slowly resolving infiltrates on chest X-ray.