Lung abscess versus necrotizing pneumonia: implications for interventionaltherapy

Objective. To assess and contrast the role of interventional therapy for tw o types of cavitating pneumonias: lung abscess and necrotizing pneumonia. Materials and Methods. We retrospectively reviewed the imaging, interventio nal therapy, and outcome of 14 children seen between February 1987 and Janu ary 1996 with lung abscess and 9 with necrotizing pneumonia. All children w ere treated with antibiotics prior to intervention. Pulmonary parenchymal f luid was percutaneously aspirated from ten lung abscesses and three necroti zing pneumonias. Percutaneous catheters drained five lung abscesses. Pleura l drainage was performed for three lung abscesses and eight necrotizing pne umonias. Results. All 14 children with lung abscesses had positive Gram stains of th e pulmonary fluid; 13 cultures were positive. All 14 defervesced within 48 h of intervention. None developed a bronchopleural fistula. All nine necrot izing pneumonias were presumed to be sequelae of prior pneumonia. Streptoco ccus pneumoniae was the only organism as documented by pleural fluid latex fixation in three patients, gram stain in two, and culture in only one. Sev en of these children developed pneumatoceles, five developed bronchopleural fistulae, and three required long-term chest tubes for persistent pneumoth oraces. Conclusion. Aggressive interventional therapy can be diagnostic and therape utic in the infected lung abscess. Interventional therapy can be harmful in postinfectious necrotizing pneumonia.