B73-42 Early Percutaneous Drainage as an Effective Modality of Treatment of a Large Lung Abscess

Abstract Introduction Lung abscess occurs as a sequelae of lung tissue infection that manifests as cavitary lesions filled with pus and necrotic debris. Although antibiotics are the mainstay of treatment, their ability to penetrate the abscess cavity is limited, necessitating drainage for effective management in many patients. We present a case of a patient with a large lung abscess successfully treated with a combination of antibiotics and early percutaneous drainage. Case Presentation A 39-year-old gentleman with a history of alcohol use disorder presented with 10 days of progressive dyspnea, productive cough, and 10-pound weight loss. He was tachycardic (HR 100), hypotensive (BP 89/52), tachypneic (RR 27), and hypoxic (SpO2 92% on room air). Examination revealed decreased air entry in the right lung. Labs showed leukocytosis (WBC 23,000, 79% neutrophils). HRCT revealed a 15X13.5X9.4cm right upper lobe abscess with bilateral patchy opacities. (Figure) He was initiated on Vancomycin and Piperacillin-Tazobactam. CT-guided percutaneous drainage was done the same day, with 350 mL of purulent fluid drained, followed by 150-200 mL/day initially. Cultures grew Klebsiella pneumoniae sensitive to Ampicillin-Sulbactam, guiding in antibiotic de-escalation. After a 17-day hospitalization and gradual reduction in drainage, he was discharged with the pigtail catheter and oral antibiotics for a total 3-week course. Follow-up CT after four weeks showed a reduction in the size, following which the pigtail catheter was removed. Discussion Variability in clinical approach to treatment of lung abscess exists even at present. The most favored approach is administering broad-spectrum antibiotic therapy, with percutaneous or surgical drainage reserved for patients who do not respond to antibiotics. Our patient presented with a large abscess of 15 cm in diameter, hypoxia, and hemodynamic instability, making early drainage appropriate rather than monitoring response to antibiotics alone. While around two-third of patients have been reported to respond to antibiotics alone, drainage has been required in the remaining cases, particularly in patients with larger and complex abscess. Although percutaneous drainage has risk of complications like bronchopleural fistula, pyopneumothorax, and empyema, recently this approach is considered more frequently before surgical drainage due to evidence of low complication and high success rates. Additionally, in cases where drainage was pursued, early drainage resulted in shortened hospital stays. Early percutaneous drainage was appropriate in our patient due to the presence of hemodynamic instability, hypoxia, and a large abscess. Guidelines that consider these factors in determining the timing of drainage are crucial to achieve a uniform approach. This abstract is funded by: None