Management of COVID-19 Infection Associated Lung Abscess with Secondary Pleural Empyema Using Percutaneous Intracavitary Drainage: Case Series and Review of the Literature

<b>Background/Objectives</b>: COVID-19-related pulmonary complications, such as lung abscesses and pleural empyema, are rare but serious. This study presents a case series of three patients with COVID-19-associated lung abscesses complicated by pleural empyema, managed conservatively with percutaneous intracavitary drainage (ICD) and lavage. We assess the efficacy and safety of this treatment and compare our findings with the current literature. <b>Methods</b>: A retrospective analysis of three cases treated at the Clinic of Thoracic Surgery and Intensive Care Unit in Cluj-Napoca, Romania, was conducted. All patients developed severe lung involvement post-COVID-19, with abscesses rupturing into the pleural cavity. Conservative management included percutaneous ICD and daily lavage with isotonic saline, avoiding extensive surgery due to the patients' critical condition. Clinical, radiological, and functional outcomes were followed, and results were compared to similar cases in the literature. <b>Results</b>: Among 496 critically ill patients with COVID-19 infection, three patients (age 42-60) developed lung abscesses and bacterial superinfection. In all patients, the germs involved were identified (monomicrobial infection in 1, polymicrobial in 2 patients). The abscesses were treated with percutaneous ICD and lavage, leading to clinical improvement in all cases. Long-term drainage (94-290 days) was necessary to obtain healing, and none of the patients required lung resection or decortication. Serial CT scans showed resolution of the abscesses and empyema. All were successfully discharged, and long-term follow-up (30-32 months) revealed minor radiological sequelae and mild respiratory impairment. The literature review found three studies summarizing 45 patients with lung abscesses complicating COVID-19 infections, but only one study addressed the use of percutaneous ICD. The mortality reported in this group was high (50-65%). <b>Conclusions</b>: Conservative treatment with percutaneous ICD and lavage is effective in managing lung abscesses and pleural empyema in critically ill COVID-19 patients, offering a viable alternative to surgery in high-risk cases. This method may be beneficial in multidisciplinary care for non-surgical candidates.