2018 Jun - Cavitary Lung Diseases: A Clinical-Radiologic Algorithmic Approach
Khalid Gafoor, DO, Shalin Patel, MD, Francis Girvin, MD, Nishant Gupta, MD, FCCP, David Naidich, MD, FCCP, Stephen Machnicki, MD, Kevin K. Brown, MD, FCCP, Atul Mehta, MD, FCCP, Bryan Husta, MD, FCCP, Jay H. Ryu, MD, FCCP, George A. Sarosi, MD, Tomás Franquet, MD, Johny Verschakelen, MD, Takeshi Johkoh, MD, PhD, William Travis, MD, Suhail Raoof, MD, Master FCCP
Chest 2018;153(6):1443–1465
Cavities occasionally are encountered on thoracic images. Their differential diagnosis is large and includes, among others, various infections, autoimmune conditions, and primary and metastatic malignancies. We offer an algorithmic approach to their evaluation by initially excluding mimics of cavities and then broadly classifying them according to the duration of clinical symptoms and radiographic abnormalities. An acute or subacute process (< 12 weeks) suggests common bacterial and uncommon nocardial and fungal causes of pulmonary abscesses, necrotizing pneumonias, and septic emboli. A chronic process (≥ 12 weeks) suggests mycobacterial, fungal, viral, or parasitic infections; malignancy (primary lung cancer or metastases); or autoimmune disorders (rheumatoid arthritis and granulomatosis with polyangiitis). Although a number of radiographic features can suggest a diagnosis, their lack of specificity requires that imaging findings be combined with the clinical context to make a confident diagnosis.
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