Pulmonary cavity

Last revised by Yuranga Weerakkody on 9 May 2024

A pulmonary cavity is a collection of gas and/or fluid enclosed by a thick and often irregular wall which usually occurs when central necrotic tissue is expelled via a bronchial connection. Cavities may be single or multiple and can be isolated or associated with lung disease 12.

Pseudocavities are areas of spared parenchyma, normal/ectatic bronchi or emphysema that appear as areas of low attenuation in nodules, masses or consolidation, thereby mimicking cavitation 12.

The cause of pulmonary cavities is broad. They may develop as a chronic complication of a pulmonary cyst or secondary to cystic degeneration of a pulmonary mass. They may enlarge or involute over time.

Pulmonary cavities may be the result of malignancy, infection, inflammation, or be congenital:

A helpful mnemonic is CAVITY

A cavitary lesion may contain gas, fluid or both, in which case there will be a gas-fluid level. A cavity can form within a pre-existing lesion (nodule, mass, or consolidation). It typically has a thick, irregular wall, often with a solid mural component. Although the findings of benign and malignant cavitary nodules overlap, a maximum wall thickness of ≤4 mm is usually benign and a wall thickness >15 mm is usually malignant. Spiculated margins also suggest malignancy.

A solitary cavitary lesion is most likely cancer or infection11.

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