Answer

Bronchiectasis with pulmonary abscess/cavity

Causes of lung cavitation are listed in Table 1.10. In the case of lung abscesses a solid nodule is the first radiological manifestation. When the necrotic centre/pus discharges into the bronchial tree, then a fluid level and the cavity wall are often visible. In addition to pyogenic infections, a parenchymal lung cavity should raise the possibility of TB. This represents reactivation disease and classically affects the apical or posterior segments of the upper lobes. Pulmonary cavities can become complicated by empyema (Fig. 1.66).

Cavitating malignancy can appear similar to infectious cavities. These may be primary bronchogenic malignancy or metastatic disease such as head and neck squamous carcinoma. Cavitating malignancy tends to have more nodular, thicker walls (more than 15 mm) than infection (less than 5 mm).

Table 1.10 Causes of lung cavities

Pyogenic abscess

Staphlococcus aureus

Beta-haemolytic streptococcus

Klebsiella

Anaerobes

Septic emboli

TB

Reactivation (apical or posterior segment of upper lobes)

Parasitic infection

Echinococcus

Malignancy

Primary or metastatic (particularly squamous cell carcinoma)

Rheumatoid nodule

Wegener's granulomatosis

Cavitating infarct

Mimics of cavitating lesions include pneumatoceles, emphesematous bullae and cystic bronchiectasis. Pneumatoceles are thin-walled intra-parenchymal areas of air trapping which occur in the recovery phase of staphylococcal pneumonia, contusion or chronic ARDS.

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