Pulmonary Abscess in Infancy and Childhood

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Abstract
A 25-year experience with 18 cases of pulmonary abscess in infancy and childhood is reported. There was no significant sex distributions and the ages of the patients ranged from seven weeks to 11 years. The pathogenesis of the abscess was regarded as post-pneumonic in the majority of cases. The abscess occurred following an episode of pneumonia or pneumonitis in two-thirds of the patients. Fever was the commonest symptom. It was encountered in 15 of the 18 cases. It was followed in order of frequency by cough, purulent sputum, weight loss and hemoptysis. The clinical features of pulmonary abscess in the pediatric age group are discussed and compared with those encountered with this disorder in adulthood. The right lung was involved in abscess formation approximately twice as often as the left. There appeared to be a greater tendency toward right middle lobe involvement in the pediatric age group. Multiple lobe involvement was encountered in four of the 18 cases. All four cases were post-pneumonic and, in all four, the right middle lobe was involved. The relative incidence of hemolytic staphylococcus aureus infection was greater in the pediatric age group. Eleven of the patients were managed by “nonoperative” measures and only two recovered. All seven patients managed by “nonoperative” measures without antibiotics died and two of the four whose “nonoperative” management included the use of antibiotics died. Nearly one-half of the deaths resulted from brain abscesses or purulent meningitis. Other fatal complications included massive pulmonary hemorrhage, rupture of the abscess into the tracheo-bronchial tree, pneumothorax and overwhelming infection. All seven of the patients on whom a direct surgical attack on the abscess was carried out recovered. Rib resection with drainage of the abscess was the only procedure utilized in one case. The remaining six cases were managed successfully by lobectomy. Eight lobes were removed in these six cases during seven operations. The decreasing incidence of pulmonary abscess in infancy and childhood and the role of pulmonary resection in the management of abscesses caused by resistant organisms are discussed.

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