A Large Lung Abscess in an Electronic Cigarette User: To Drain or Not to Drain

Abstract

A lung abscess is a walled necrotizing infection involving the lung parenchyma, characterized by a cavitary lesion filled with fluid. It is usually caused by microbial infection with aspiration of oropharyngeal contents being the most common mechanism for primary lung abscesses. Secondary lung abscesses occur in the presence of predisposing lung conditions like bronchial obstruction, vascular or septic emboli or impaired host defenses. Lung abscesses caused by electronic cigarette use have gained relevance in the recent years since the outbreak of EVALI, that is, e-cigarette or vaping product use-associated lung injury, in 2019. First-line therapy involves prompt initiation of antibiotics given their success rate in the treatment of lung abscess in the current potent antibiotic era. Percutaneous aspiration and catheter drainage is considered a second line approach due to concerns for potential complications including catheter blockage necessitating repeat procedures, pneumothorax, hemothorax, hemoptysis, need for surgical intervention, infection of pleural space and bronchopleural fistula. We describe a case of a 21-year-old female with a history of electronic cigarette use presenting with a large left upper lobe lung abscess (14.5 x 8.5 x 13.3 cm) treated successfully with broad-spectrum antibiotics alone resulting in clinical and radiologic improvement.

Keywords: e-cigarette and vaping product use associated lung injury (evali); electronic cigarette associated lung injury; necrotizing pneumonia; percutaneous drainage of chest and abdominal colllections; • lung abscess.

Figure 1. Chest X-ray on presentation showing the left-sided lung abscess

Figure 2. Chest CT on presentation showing a loculated left-sided lung abscess with air fluid levels

Figure 3. Chest X-ray done three weeks after antibiotics showing resolution of air fluid levels and improvement in the left lung abscess

Figure 4. Chest CT done after five weeks of antibiotics showing significant improvement and resolution of air fluid levels