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Causes of cavitary lung lesions Bacterial infections o Community acquire pneumonia – especially Klebsiella pneumoniae and Staphylococcus aureus o Pulmonary actinomycosis Very aggressive – chest wall invasion, transfissural extension and hilar and mediastinal lymphadenopathy may be seen o Septic emboli Cavitary lesion usually in periphery of lung Multiple lesions usually found “feeding vessel” sign may be present on CT Primary lung cancers o Squamous cell ca 82% o Adenocarcinoma o Large cell carcinoma o Small cell carcinoma never cavitates Cavitation is reported in 2-16% of primary lung Ca Multiple cavitary lesions are rare but suggestive of multifocal bronchoalveolar cell ca Measurement of cavity wall thickness is most useful in predicting malignancy o ≤ 4mm – 94% benign o 5mm to 15mm – 60% benign and 40% malignant o >15mm – 90% malignant Other features of cavities on CT scan suggestive of malignancy o Notching – 29% benign 54% malignant o Irregular internal wall – 26% benign and 49% malignant Findings suggestive of benign origin o Linear margin o Bronchial wall thickening o Consolidation and o Ground glass attenuation o ‘air-crescent’ sign s/o inflammatory process Pulmonary metastases Occurs less frequently than in primary cancers 4% of metastatic lung tumors may show cavitations Squamous cell ca most common – 69% Non malignant cavitary diseases Tuberculosis o Common in post primary TB o Usually located in apical and posterior segments of upper lobes and superior segments of lower lobes o Prevalence of 30-50% of TB patients o May be multiple with thick/thin walls o Very difficult to radiologically differentiate TB and malignancy Nontuberculous mycobacterial infection o Mycobacteria kansasii and M.avium-intracellulare complex o 65% of MAC patients have cavitation o Associated findings include nodules with associated Bronchiectasis Fungal infections o Aspergilloma – usually in a pre-existing cavity Round soft tissue within pre-existing cavity o Cryptococcois Cavitation in 14-42% of cases, no differentiating features o Pulmonary blastomycosis o Histoplasmosis o Coccidioidomycosis o Mucormycosis Non infectious inflammatory diseases o Necrobiotic Rheumatoid nodules Typically men with subcutaneous nodules, high RF and pulmonary interstitial pneumonia Multiple nodules may be seen o Wegener’s granulomatosis May present as single nodule with cavitation or multiple Cavitation occurs in 50% of cases Lesions represent active disease and may resolve on treatment o Eosinophilic granulomatosis Sparing of costophrenic sulci hallmark of disease Miscellaneous rare cause of cavitation o Immunosuppressed patients Aspergillosis Pulmonary nocardiosis o Use of novel chemotherapy agents – cavitation of existing lung ca o Post radiotherapy ablation of tumors