Review
Cystic and Cavitary Lung Diseases: Focal and Diffuse

https://doi.org/10.4065/78.6.744Get rights and content

Cysts and cavities are commonly encountered abnormalities on chest radiography and chest computed tomography. Occasionally, the underlying nature of the lesions can be readily apparent as in bullae associated with emphysema. Other times, cystic and cavitary lung lesions can be a diagnostic challenge. In such circumstances, distinguishing cysts (wall thickness =4 mm) from cavities (wall thickness >4 mm or a surrounding infiltrate or mass) and focal or multifocal disease from diffuse involvement facilitates the diagnostic process. Other radiological characteristics, including size, inner wall contour, nature of contents, and location, when correlated with the clinical context and tempo of the disease process provide the most helpful diagnostic clues. Focal or multifocal cystic lesions include blebs, bullae, pneumatoceles, congenital cystic lesions, traumatic lesions, and several infectious processes, including coccidioidomycosis, Pneumocystis carinii pneumonia, and hydatid disease. Malignant lesions including meta-static lesions may rarely present as cystic lesions. Focal or multifocal cavitary lesions include neoplasms such as bronchogenic carcinomas and lymphomas, many types of infections or abscesses, immunologic disorders such as Wegener granulomatosis and rheumatoid nodule, pulmonary infarct, septic embolism, progressive massive fibrosis with pneumoconiosis, lymphocytic interstitial pneumonia, localized bronchiectasis, and some congenital lesions. Diffuse involvement with cystic or cavitary lesions may be seen in pulmonary lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis, honeycomb lung associated with advanced fibrosis, diffuse bronchiectasis, and, rarely, metastatic disease. High-resolution computed tomography of the chest frequently helps define morphologic features that may serve as important clues regarding the nature of cystic and cavitary lesions in the lung.

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

REFERENCES (71)

  • JM Goo et al.

    CT of tuberculosis and nontuberculous mycobacterial infections

    Radiol Clin North Am

    (2002)
  • M Goldman et al.

    Fungal pneumonias: the endemic mycoses

    Clin Chest Med

    (1999)
  • BA Cunha

    Pneumonias in the compromised host

    Infect Dis Clin North Am

    (2001)
  • MP Hiorns et al.

    Acute lung disease in the immunocompromised host

    Radiol Clin North Am

    (2001)
  • DW Denning

    Chronic forms of pulmonary aspergillosis

    Clin Microbiol Infect

    (2001)
  • T Franquet

    High-resolution CT of lung disease related to collagen vascular disease

    Radiol Clin North Am

    (2001)
  • TI Morgenthaler et al.

    Cavitary pulmonary infarct in immunocompromised hosts

    Mayo Clin Proc

    (1995)
  • M Akira

    High-resolution CT in the evaluation of occupational and environmental disease

    Radiol Clin North Am

    (2002)
  • EJ Sullivan

    Lymphangioleiomyomatosis: a review

    Chest

    (1998)
  • TE Hartman

    CT of cystic diseases of the lung

    Radiol Clin North Am

    (2001)
  • LC Costello et al.

    High frequency of pulmonary lymphangioleiomyomatosis in women with tuberous sclerosis complex

    Mayo Clin Proc

    (2000)
  • J Collins

    CT signs and patterns of lung disease

    Radiol Clin North Am

    (2001)
  • JH Ryu et al.

    Idiopathic pulmonary fibrosis: current concepts

    Mayo Clin Proc

    (1998)
  • G McGuinness et al.

    CT of airways disease and bronchiectasis

    Radiol Clin North Am

    (2002)
  • WJ Tuddenham

    Glossary of terms for thoracic radiology: recommendations of the Nomenclature Committee of the Fleischner Society

    AJR Am J Roentgenol

    (1984)
  • JH Austin et al.

    Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society

    Radiology

    (1996)
  • JH Woodring et al.

    Solitary cavities of the lung: diagnostic implications of cavity wall thickness

    AJR Am J Roentgenol

    (1980)
  • MR Chaudhuri

    Primary pulmonary cavitating carcinomas

    Thorax

    (1973)
  • MR Chaudhuri

    Cavitary pulmonary metastases

    Thorax

    (1970)
  • W Mitlehner et al.

    Value of computer tomography in the detection of bullae and blebs in patients with primary spontaneous pneumothorax

    Respiration

    (1992)
  • LS Wallace et al.

    Unusual radiological manifestations of acquired pulmonary cysts in children

    JAMA

    (1982)
  • DA Stevens

    Coccidioidomycosis

    N Engl J Med

    (1995)
  • DJ Conces

    Endemic fungal pneumonia in immunocompromised patients

    J Thorac Imaging

    (1999)
  • CA Crans et al.

    Imaging features of Pneumocystis carinii pneumonia

    Crit Rev Diagn Imaging

    (1999)
  • PM Boiselle et al.

    The changing face of Pneumocystis carinii pneumonia in AIDS patients

    AJR Am J Roentgenol

    (1999)
  • Cited by (158)

    • Lemierre's syndrome—A diagnostic challenge

      2023, Diagnostic Microbiology and Infectious Disease
    • Cystic lung diseases: Diagnostic approach with computed tomography

      2022, Journal d'imagerie diagnostique et interventionnelle
    • Unusual case of cavitary lung metastasis of esophageal cancer: A case report

      2021, International Journal of Surgery Case Reports
    • Pulmonary tuberculosis presenting as diffuse cystic lung disease: An atypical manifestation

      2020, Indian Journal of Tuberculosis
      Citation Excerpt :

      Cystic lung disease represents a diverse group of uncommon disorders which pose a diagnostic challenge to the physician. The term ‘lung cyst’ is used to refer to a well defined and well circumscribed rounded/irregular lesion with a visible wall.2 Lung cysts may be an isolated finding in a disease or may be associated with other abnormalities.

    View all citing articles on Scopus
    View full text