Aspiration of intrathoracic abscess. Resultant acute ventilatory failure

Three cases illustrate that acute respiratory failure may be precipitated by spontaneous drainage of lung abscess or pleural empyema intrabronchially with diffuse aspiration of the contents bilaterally. This condition is especially hazardous if the cavity is large and the patient is debilitated or obtunded. The acute onset may mimic aspiration of gastric contents. Immediate studies of tracheal aspirate and roentgenograms of the chest should define the aspiration of intrathoracic abscess contents as the cause of acute respiratory failure.