ReviewCystic and Cavitary Lung Diseases: Focal and Diffuse
Section snippets
FOCAL OR MULTIFOCAL CYSTIC LUNG LESIONS
Cystic airspaces that present as focal or multifocal lesions usually represent bullae, blebs, pneumatoceles, infectious cysts, and congenital cystic lesions (Table 1). A bulla is generally defined as a sharply demarcated air-containing space of 1 cm or more in diameter within the lung that possesses a smooth wall that is less than 1 mm in thickness.1, 7 Bullae usually result from coalescence of emphysematous spaces or from a Ball-valve type of airway obstruction. A bleb is a localized
FOCAL OR MULTIFOCAL CAVITARY LUNG LESIONS
The differential diagnosis of a cavitary lesion is broader than that of a cystic lesion and includes neoplasms (bronchogenic cancer, lymphoma, metastasis), many types of infectious processes and abscesses (bacteria, mycobacteria, fungi, parasites), pulmonary infarct, septic embolism, vasculitides, congenital anomalies (sequestration, congenital adenomatoid malformation), rheumatoid nodule, and progressive massive fibrosis occurring with pneumoconiosis. More often than not, cavitation implies an
DIFFUSE CYSTIC AND CAVITARY LUNG DISEASES
Diffuse implies involvement of all lobes of both lungs. Although the disease necessarily is widespread, it need not affect all lung regions uniformly. The differential diagnosis of diffuse cystic or cavitary diseases is limited compared with that of focal or multifocal involvement. Diffuse cystic disease is classically associated with 2 uncommon lung diseases, LAM and PLCH (Table 2). In these 2 diseases, innumerable cystic spaces may not be individually identifiable on chest radiography because
CONCLUSIONS
Cystic and cavitary lung lesions can be caused by a diverse array of pathologic processes. In evaluating a patient with such lung lesions, it is helpful to distinguish cysts from cavities and to categorize focal or multifocal vs diffuse distribution. These characteristics correlated with the tempo of the disease process and the clinical context provide the basis for prioritizing the diagnostic possibilities that will guide the subsequent evaluation.
High-resolution CT of the chest is a valuable
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