A lung abscess is a subacute infection that destroys lung parenchyma. Further, chest radiographs reveal one or more cavities, often with an air-fluid level. Because the development of a cavity requires some amount of prior tissue damage and necrosis, presumably, lung abscesses usually begin as a localized pneumonia.
Contraindications to surgery
Several important factors must be considered prior to undertaking surgery. Because of the high risk of spillage of the abscess into the contralateral lung, it is almost essential that a double-lumen tube be used to protect the airway. If this is not available, surgery poses a very high risk of abscess in the other lung and a risk of ARDS. In such cases, postponing the surgery is a wise decision. Another, less-satisfactory method to deal with this problem includes positioning the patient in the prone position. The surgeon must be skilled in resecting the abscess and in rapid clamping of the bronchus to prevent spillage into the trachea. These factors are extremely important when dealing with the surgical aspects of treating a lung abscess. If doubt persists, postponing the surgery is best.