Cavitary Lung Lesions - A diagnostic approach · Page 3 of 30 Sometimes, distinguish a pulmonary...

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Cavitary Lung Lesions - A diagnostic approach

Poster No.: C-0703

Congress: ECR 2015

Type: Educational Exhibit

Authors: S. Dutra1, D. Garrido1, R. Amaral1, S. Serpa1, D. N. Silva1, I. C. S.

P. Basto1, P. Cordeiro2; 1Ponta Delgada/PT, 2Coimbra/PT

Keywords: Tissue characterisation, Neoplasia, Abscess, Localisation, CT,Conventional radiography, Lung

DOI: 10.1594/ecr2015/C-0703

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Learning objectives

To recognize the imaging findings characteristics of the cavitary lung lesions, in theseveral imaging methods, focusing on chest computed tomography with a review of theseveral conditions that are included in the differential diagnosis and illustration with casesfrom our institution.

Background

Pulmonary cavity is a gas filled area of the lung in the center of a nodule or area ofconsolidation and may be clinically observed by many imaging methods, with the chestradiography and chest CT scan being the method of choice.

Cavities are frequent manifestations of a wide variety of pathological processes involvinglung, such as infectious, non-infectious, benign or malign processes, among others. Thepresence of a cavity helps the clinician to focus the diagnostic evaluation, as somediseases are commonly associated with cavities than others. Some aspects can help usto reduce the differential diagnosis, like the site of the cavity, its outline, wall thickness,the number, the presence of fluid level, contents of the cavity, satellite lesions and theappearance of the surrounding lung tissue.

Imaging is important not only in detection and differential diagnosis of this cavities, butalso for the management of the pathology.

Findings and procedure details

A cavity is the result of a number of pathological processes and results from the expulsionof a necrotic part of the lesion into the bronchial tree. The likelihood that a given processwill cavitate depends upon both host factors and the nature of the underlying pathogenicprocess. In general, certain processes tend to form cavities more commonly than others.

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Sometimes, distinguish a pulmonary cyst from a cavitary lung lesion can be a diagnosticchallenge. A pulmonary cyst is usually defined as a thin-walled (usually less than 3mm),well-marginated, and circumscribed air- or fluid-containing lesion that is 1 cm or more indiameter. A cavity is a lucency within a zone of pulmonary consolidation, a mass, or anodule. It may or may not contain an air-fluid level, and it is surrounded by a wall of variedthickness but usually greater than 3mm in diameter. This distinction is useful becausediagnostic consideration and approach differ for theses two categories, although someoverlap exists.

Pulmonary cavities may be the result of a wide variety of pathological processes that arelisted below:

• Cavitating malignancy

• Primary bronchogenic carcinomas (especially squamous cellcarcinoma)

• Pulmonary metastases - cavitating pulmonary metastases

• Squamous cell carcinoma• Adenocarcinoma, e.g. gastrointestinal tract, breast• Sarcoma

• Infection

• Pulmonary tuberculosis• Pulmonary bacterial abscess• Necrotizing pneumonia• Post pneumotic pneumatocele• Septic pulmonary emboli• Other infections

• Pulmonary coccidioidomycosis• Pulmonayr fungal infections - eg. aspergilloma• Pulmonary actinomycosis - thoracic actinomycosis• Pulmonary nocardiosis• Melioidosis• Pulmonary cryptococcosis

• Autoimune disease, Vasculites and Granulomatoses

• Wegener´s granulomatosis• Rheumatoid arthritis (rheumatoide nodules)• Sarcoidosis• Lymphomatoid Granulomatosis

• Vascular

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• Pulomonary infarct• Trauma

• Pneumatocoeles• Congenital

• Congenital cystic adenomatoid malformation (CCAM)• Pulmonary sequestration• Bronchogenic cyst

RADIOLOGICAL FEATURES

Some radiological features can help us in the differential diagnosis, and we will resumethem in the following table.

1. Number

Single cavity Multiple bilateral cavities (suspicionfor bronchogenous or hematogennousprocess)

Primary lung cancer

Post traumatic lung cysts

(…)

Abscesses

Lymphoma

Metastases

Rheumatoid nodules

Wegener´s granuloma

Vasculitis (Wegners)

Septic pulmonary infarcts

Coccidiomycosis

Tuberculous

2. Size - A large cavity encompassing the entire lobe or lung should raise suspicion forgangrene of lung.

3. Location

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Patology Location

Aspiration lung abcess Right sided and lower zone

Tuberculous Posterior segments of the upper lobes orapical segments of the lower lobes.

Lung cancer Can occur in any segment but if it occurin anterior segment a strong suspicionshould be raised (TB and aspiration lungabscess are rare in this segment)

Amoebic abscesses Right lower lobe (infection extendingdirectly from the liver)

Pulmonary infarcts Lower lung zones peripherally

4. Wall thickness

As more thin as the wall is, bigger is the probability to be benign. As more thick the wallis, bigger is the probability to be malignant. So, walls thickness < 2 mm, benign in almost100% and walls thickness > 15 mm, malignant in almost 100%.

Thick walls Thin walls

Malignant tumors

Metastases

Acute Tuberculous

Lung abscess

Wegener´s granulomatosis

Blastomycosis

Septic pulmonary infarcts

Pneumatoceles

Chronic tuberculous

Coccidiomycosis

M. Kansasii infection

Congenital or acquired bullae

Posttraumatic cysts

5. Morphology

Eccentric cavity and shaggy internal margins are related to malignant.

Ill-defined and downy are related to abscess.

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Smooth are related to other etiologies

6. Contents

Fluid levels are common in primary tumors.

Irregular masses of blood clot or necrotic tumor may be seen within the cavity.

Cavitating metastases and tuberculous cavities contain fluid frequently.

7. Meniscus sign

An aspergilloma within a cavity gives rise to the meniscus sign of a crescentic air shadowabove the fungus ball. Movement occurs with change in patient position. When an hydatidcyst ruptures the daughter cysts floating within the cavity appear like a water lily, hencethe water lily sign. Other lesions which may be seen within a cavity include inspissatedpus, cavernoliths or blood clot. Blood clot may occur in cavitating neoplasms, tuberculosisand pulmonary infarcts.

DIFFERENCIAL DIAGNOSIS

1. Noninfectious diseases associated with lung cavities

1.1. Malignancies

One of the most important distinctions in the differential diagnosis of cavitary lung lesionsis the distinction between malignant and nonmalignant etiologies.

Primary lung cancer is a common disease and 15% of peripheral lung cancer cavitate.The cavity is frequently eccentric, the wall is often irregular, and tumor nodules maybe visible. The thickness of the cavity wall usually exceeds 8 mm and varies markedlyin different portions of the tumour. Cavitation is more frequently found among cases ofsquamous cell carcinoma than other histological types, whereas small (oat) cell almostnever cavitates. Approximately one third of squamous cell carcinoma occur in the lungperiphery and the most characteristic is a thick-walled cavitary mass that usually does

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not have an air-fluid level. The diameter range from 2 to 10cm. The cavity may beindistinguishable radiographically from a primary lung abscess. A solitary nodule or masswithout cavitation can occur in the periphery of the lung parenchyma. Fig. 1.

Fig. 1: Lung tumor with cavitationReferences: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

Metastatic disease from other primary sites may also cavitate, but this occurs lessfrequently than in primary lung cancers (5% of cases). Cavitation occurs most often insquamous cell carcinomas that are metastatic from the head and neck in men, from thecervix in women, and from transitional carcinoma. CT is considerably more sensitive thanplain radiographs in detecting lung nodules in patients with metastatic tumor, althoughthe sensitivity of CT varies with slice thickness. The cavities are typically thick walled.Cavities can also occur after treatment of metastases.

Complicating the diagnostic evaluation of cavitary lung lesions is the non-infrequentcoexistence of pulmonary infection and malignancy.

1.2. Autoimmune disease, Vasculites and Granulomatoses

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Many autoimmune diseases can affect the lung, but cavitation is relatively uncommonin most of these disease. The exception is Wegener´s granulomatosis, an uncommondisorder in which cavitary lung disease is frequently encountered.

Wegener´s granulomatosis is a systemic vasculitis that almost always involves theupper or lower respiratory tract. At presentation, chest radiographic abnormalities arevisible in 75% of patients. The most common and characteristic pattern is that of multiple,rounded nodules or masses that usually are well defined and that range in size from a fewmillimeters to 9 cm in diameter. They may cavitate (approximately in 50% of cases), andthey are commonly bilateral and multiple. The cavities have thick, irregular walls and air-fluid level may be present . Typically, cavitary nodules and masses become thin walledand decrease in size with treatment. The nodules may be peripheral in location and maysimulate pulmonary infarcts.

Sarcoidosis is a relatively common inflammatory disorder of unknown etiology thatfrequently affects the lungs. Plain chest radiographic findings are often nonspecific:conventional and hig-resolution computed tomography are better modalities for showingcharacteristic features of pulmonary sarcoidosis. Lung nodules are frequently observedand tend to be distributed along the broncovascular bundles, interlobular septa, majorfissure, and subpleural regions. Cavitation occasionally occurs within these nodules.

Rheumatoide arthritis is also commonly associated with pulmonary abnormalities, butcavities due primarily to rheumatoid arthritis are rare. Lung cavities in patients withrheumatoid arthritis often represent infection r carcinoma, so aggressive diagnosticevaluation is warranted for new cavitary lesions in these patients.

Pulmonary cavities are less frequently encountered in other autoimmune diseases.Given that most patients with these diseases are treated with potent immunosuppressiveagents, infectious etiologies for cavitary lesions should be aggressively investigated.

1.3. Lymphomatoid Granulomatosis

Lymphomatoid granulomatosis is a systemic disease characterized by anangiocentric, angiodestructive, lymphoreticular, granulomatous vasculitis that primarilyinvolves the lung but frequently involves the kidneys, skin and central nervous system.

The radiographic features are similar to those of Wegener´s. The most commonradiographic presentation consists of multiple pulmonary nodules that range in size from 1to 10 cm. The nodules are often much more numerous that in Wegeners´s granulomatosisand may simulate advanced metastatic disease. On CT, the nodules have a perilymphaticdistribution, clustering along bronchovascular bundles ad interlobular septa. The lowerlung zones are more frequently involved , and the nodules may be ill defined initially. The

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occasionally coalesce, producing a more pneumonic appearance. Cavitation is commonand hilar adenopathy is rare. Thin-walled cyst lesions may also be observed.

2. Infections associated with lung cavities

2.1. Common Bacterial Infections

Infections caused by commonly bacteria may cause pulmonary cavities by one of twomechanisms: via the upper airway, bypassing host defenses and causing necrotizingpneumonia or lung abscess or via the bloodstream causing septic pulmonary emboli. Theradiographic appearance and microbiological etiologies are distinct and will be discussedseparately.

2.1.1. Necrotizing pneumonias and lung abscesses

Necrosis of the lung parenchyma with cavitation occurs in pneumonia, particularly thatproduced by virulent bacteria, including S. Aureus, streptococci, gram-negative bacilli,and anaerobic bacteria. If the inflammatory process is localized, a lung abscess will form.It is usually rounded and focal, and it appears to be a mass. Multiple, small cavitiesor microabscesses may develop in necrotizing pneumonia. They are recognized asmultiple areas of lucency within a consolidated lobe or segment A similar appearancemay be produced by consolidation superimposed on areas of preexisting emphysema.If the necrosis is extensive, arteritis and vascular thrombosis may occur in an area ofintense inflammation, causing ischemic necrosis and death of a portion of lung. This is aparticular complication of Klebsiella pneumonia and other pneumonias producing lobarenlargement. The radiographic features include multiple areas of cavitation, often withair-fluid levels. Portions of dead lung may slough and form intracavitary masses. Fig. 2,3.

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Fig. 2: Necrotizing pneumonia with cavitations within the left upper lobeReferences: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

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Fig. 3: Necrotizing pneumonia with cavitations within the left upper lobeReferences: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

A lung abscess represents a localized infection that undergoes tissue destruction andnecrosis. When a communication with the tracheobronquial tree is present, cavitationand an air-fluidlevel may be evident. The inner wall of an abscess varies from smoothto shaggy and irregular, ad maximum wall thickness usually ranges from 5 to 15mm.Pulmonary abscess are most commonly caused by mixed anaerobic infections, followedin frequency by S. Aureus and Pseudomonas aeroginosa. Such infections are often theresult of aspiration. Consequently, a lung abscess is often encountered in patients atrisk for aspiration, such as patients with poor dental hygiene, impaired consciousness,esophageal motility disorders, and neurologic diseases. Fig. 4,5,6,.

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Fig. 4: Cavitary lung lesion with air-fluid level in the anterior segment of the right upperlobe in a patient with pneumonia - lung abscessReferences: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

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Fig. 5: Cavitary lung lesion with air-fluid level in the anterior segment of the right upperlobe in a patient with pneumonia - lung abscessReferences: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

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Fig. 6: Cavitary lung lesion with air-fluid level in the upper right lobe - lung abscessReferences: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

2.1.2. Septic pulmonary emboli

Septic pulmonary emboli causing septic infarcts, although relatively rare, are importantconsiderations in the differential diagnosis of cavitary lung lesions. Actually the etiologiesof septic pulmonary embolism are dominated by infected intravascular prosthetic materialsuch as intravascular catheters, pacemaker wires, and right-sided prosthetic valves.Septic pulmonary emboli associated with intravenous drug use are caused predominantlyby S. Aureus. Septic infartcs tend to be multiple and peripheral and to abut the pleuralsurface. They occur more frequently iin the lower lobes. These nodules or wedge-shapedopacities may show evidence of cavitation. CT often demonstrates a vessel connectedto the area of infarction. On CT, the septic infarcts appear a wedge-shaped, peripheral

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opacities abutting the pleura. They may contain air bronchograms or rounded lucenciesof air, sometimes referred to as pseudocavitaion. True cavitation is common. Fig. 7,8.

Fig. 7: Nodular opacities with cavitation in a drug addict patient with an history ofinfective endocarditis - septic pulmonary emboliReferences: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

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Fig. 8: Nodular opacities with cavitation in a drug addict patient with an history ofinfective endocarditis - septic pulmonary emboliReferences: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

2.2. Post Pneumotic Pneumatoceles

Cavities may develop in pyogenic and nonpyogenic infections and thin -walled cystscalled pneumatoceles are a complication of some infections. Pneumatoceles ae usuallyassociated with pneumonia caused by virulent organisms; the classic offender is S.Aureus. They usually form subpleural collections of air, which result from alveolar rupture.Radiographycally, they appear as single or multiple, cyst lesions with thin and smoothwalls and do not contain air-fluid levels. They may show rapid change size and locationon serial radiographs.

2.3 Mycobacterial Infections

Pulmonary tuberculosis, caused by mycobacterium tuberculosis, has been an infectionof importance throughout history. Although tuberculosis case rates have declined in

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man developed countries there are still numerous factors that influence the likelihoodof contracting tuberculosis like the socioeconomic status, immune system integrity, age,general state of health, among others. Several different patterns of tuberculosis infectionhave been described, differing in pathologic, clinical, and radiologic manifestations.These include primary MTB, progressive primary MTB and postprimary MTB. Patientswith primary MTB most often show no radiologic abnormalities. If overt infection occurs,the pattern is usually one of air-space consolidation often involving an entire lobe.The right lobe is more commonly affected than the left. Cavitation in primary MTBis unusual, but when present is more frequently reported in adults than in children.Rarely, a parenchymal focus of primary MTB infection becomes rapidly progressive.Extensive consolidation and cavitation develop, either at the site of the initial pulmonaryparenchymal focus of infection or in the apical and posterior segments of the upper lobes.

Usually, postprimary MTB occurs as a result of previously latent infection and is oftenassociated with progressive disease. The most typical finding is that of poorly definedareas of consolidation favoring the apical and posterior segments of the upper lobes and,to a lesser extent, the superior segments of the lower lobes. The characteristic areasof cavitation are seen in 20% to 45% of patients with active postprimary MTB on chestradiographs, but small cavities are more easily appreciated with CT. Cavities may bethick or thin walled; air-fluid levels are relatively uncommon,

As the inflammation mounts, tissue destruction occurs and caseous material liquefies andmay acquire communication with the tracheobronchial tree, producing the characteristicpathologic and radiologic finding of postprimary MTB: cavitation . Fig. 9,10,11,12,13.

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Fig. 9: Residual lung lesions of old pulmonary tuberculosisReferences: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

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Fig. 10: Cavitated pulmonary tuberculosisReferences: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

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Fig. 11: Cavitated pulmonary tuberculosisReferences: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

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Fig. 12: Two cavitation in left upper lobe of the lung - reactivation of pulmonartuberculosisReferences: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

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Fig. 13: Nodular opacity with cavitation in left upper lobe in a patient with family historyof tuberculosis - Pulmonary tuberculosisReferences: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

2.4. Fungal Infections

Aspergilloma

Aspergilloma, or mycetoma, is a saprophytic infection that occus in patients withunderlying structural lung disease. Patients with mycetoma generally have normalimmunity although coexistent chronic disease are often present. The most commoncause of underlying structural lung disease in patients with aspergilloma is cavitarydisease from prior TB. Structural lung disease due to sarcoidosis is the second mostcommon condition predisposing to aspergilloma formation. Bullae, abscesses, andbronchiectasis are less common predisposing factors. Aspergilloma usually appears asa round or oval mass partially filling a cavity and creating the characteristic finding ofthe air-crescent sign. It fungus ball completely fills the pulmonary cavity, the air-crescentsign may not be discernible. Aspergillomas often show mobility with decubitus imaging.Aspergillomas are usually located in the upper lobes, adjacent to the pleura, which maybe thickened. Aspergillomas rarely calcify, and they may diminish or remain unchanged insize over the time. An air-fluid level is usually not present within the cavity The cavity itselfis usually thin walled, although thickening of the cavity walls before a discrete internal

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opacity is seen may indicate early infection. CT shows a mobile, intracavitary mass andmay also reveal small fungal strands bidging the fungus ball and the cavity wall in caseswhen the air-crescent sign is not visible on chest radiographs. As with chest radiography ,CT may reveal thickening of the wall of a preexisting cavity before the fungus ball isevident. Fig. 14,15,16.

Fig. 14: Round mass partially filling a cavity with the characteristic finding of the air-crescent sign - Aspergilloma.References: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

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Fig. 15: Two cavitary lung lesions filled with a mass with the air-crescent sign andshowing mobility with decubitus imaging - dorsal decubitus - AspergillomaReferences: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

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Fig. 16: Two cavitary lung lesions filled with a mass with the air-crescent sign andshowing mobility with decubitus imaging - ventral decubitus - AspergillomaReferences: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

2.5. Posttraumatic pneumatoceles

Posttraumatic pneumatoceles result from penetrating or nonpenetrating trauma andfrom laceration of the lung parenchyma, They are usually unilateral and peripheral inlocation at the site of injury. Traumatic lung cysts may be filled with blood initially.However, communication with the bronchus may occur, creating an air-fluid level. Thesepneumatoceles usually resolve in a few weeks, whereas hematomas may require monthsto resolve. Fig. 17,18.

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Fig. 17: Posttraumatic pneumatoceleReferences: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

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Fig. 18: Posttraumatic pneumatoceleReferences: Radiologia, Hospital do Divino Espírito Santo de Ponta Delgada, Hospitaldo Divino Espírito Santo de Ponta Delgada - Ponta Delgada/PT

2.6. Pulmonary infarcts

Pulmonary infarcts rarely undergo cavitation. However, described above, if there isassociated infection, usually as a result of septic emboli, cavitation may occur. The classicfeatures consist of ill-defined cavities at the bases of the lungs.

3. Cavitary lung disease in immunocompromised patients

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Cavitation within either focal ir diffuse lung parenchymal opacities in immunosuppressedpatients is usually caused by bacterialinfection, including N. asteroids and mycobacterialinfectio, and fungal infection. In patients with severe bone marrow suppression, suchas chemotherapy patients or patiens several weeks after bone marrow transplantation,bilateral, multifocal, nodular opacities that quickly undergo cavitation are very suggestiveof invasive aspergillosis.

Cavitation of upper lobe parenchymal opacities may occur in relatively immunocompetentpatients with mycobacterial infections. Cavitation in mycobacterial infections in HIV-infected patients with CD4 cell counts below 200 cells/µL is uncommon, however, andthe presence of cavitation within focal or diffuse opacities in such patients favors eithernecrotizing pyogenic pneumonia or fungal infection.

Conclusion

Cavitary lung lesions represents a frequent clinical condition and are associated to a verydifficult diagnosis, taking in account its enormous presentation variability and the numberof possible differential diagnosis.

The radiologist plays an important role in the diagnosis and assessment of this entity. Weshould be familiarized with the several possible differential diagnosis and typical imagingfindings, allowing a more precise diagnostic and therapeutical management.

Personal information

References

1. WEBB, W. Richard et al. Fundamentals of Body CT. 4th edition, California, ELSEVIERSaunders, 2014.

2. WEGENER, Otto H. et al. Whole Body Computed Tomography. 2nd edition, Germany,Blackwell, 1992.

3. BURGENER, Francis A. et al. Differential Diagnosis in Computed Tomography. 2ndedition, New York, Thieme, 2011.

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4. PROKOP, Mathas et al. Spiral and Multislice Computed Tomography of the Body. 1stedition, Germany, Thieme, 2003.

5. SUTTON, David et al. A textbook of Radiology and Imaging. 6th edition, London,Churchill Livingstone, 1998.

6. GRAINGER R.G. et al. Diagnostic Radiology. 5th edition, Edinburgh, ChurchillLivingstone, 2007.

7. Ryu JH, Swesen SJ. Cystic and cavitary lung diseases: focal and diffuse, Mayo ClinicProc. 2003 Jun; 78(6):744-52.

8. Gadkowski LB, Stout JE. Cavitary pulmonary disease. Clin Microbiol Rev. 2008Apr;21(2):305-33.

9. Chiu FT. Caviation in lung cancers. Aust N Z J Med. 1975 Dec;5(6):523-30.

10. O'Connell C, Abdul Aziz M, O'Keane JC, Healy D, O'Callaghan DS. Differentiatingpulmonary cavities. Eur Respir Rev. 2013 Jun 1;22(128):191-2.

11. Honda O, Tsubamoyo M, et al. Pulmonary cavitary nodules on computedtomography: differentiation of malignancy and benignancy. J Comput Assist Tomogr.2007 Nov.Dec;31(6):943-9.

12. Vourtsi A, Gouliamos A, Moulopoulos L, Papacharalampous X, Chatjiioannou A,Kehagias D, Lamki N., CT appearance of solitary and multiple cystic and cavitary lunglesions. Eur Radiol. 2001;11(4):612-22.

13. Leung AN. Pulmonary tuberculosis: the essentials.Radiology. 1999Feb;210(2):307-22.

14. Horger M, Einsele H, Schumacher U, Wehrmann M, Hebart H, Lengerke C,Vonthein R, Claussen CD, Pfannenberg C. Invasive pulmonary aspergillosis: frequencyand meaning of the "hypodense sign" on unenhanced CT. Br J Radiol. 2005Aug;78(932):697-703.

15. Martinez F, Chung JH, Digumarthy SR, Kanne JP, Abbott GF, Shepard JA, MarkEJ, Sharma A. Common and uncommon manifestations of Wegener granulomatosis atchest CT: radiologic-pathologic correlation. Radiographics. 2012 Jan-Feb;32(1):51-69.doi: 10.1148/rg.321115060

16. Wilson AG, Joseph AE, Butland RJ. The radiology of aseptic cavitation in pulmonaryinfarction. Clin Radiol. 1986 Jul;37(4):327-33.

17. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. FleischnerSociety: Glossary of terms for thoracic imaging. Radiology. 2008. Mar; 246(3):697-722.

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