Ruptured Lung Abscess Into the Pleural Cavity: The Significance of Imaging and Medication Compliance

A lung abscess is defined as a necrotizing infection with a pus-filled cavity. The infection can be primary in a previously normal lung or secondary to a pre-existing condition such as bronchial obstruction or immunosuppression by HIV or steroid use. Abscesses are more common in men aged 54-74 years, with a history of smoking, alcohol or other sedative use, and immunodeficiency. We present a case of a 65-year-old male with a past medical history of chronic obstructive pulmonary disease (COPD) who presented two months following a necrotizing pneumonia infection and was diagnosed with an acute pulmonary embolism. Due to repeated imaging, an incidental left lower lobe abscess rupture with a bronchopleural fistula was discovered. This case emphasizes the importance of previous chest imaging to establish the disease course, response to therapy, medication compliance, and evaluation for intervention, particularly in underserved populations.