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.
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Terminology
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.
Pathology
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.
Etiology
Pulmonary cavities may be the result of malignancy, infection, inflammation, or be congenital:
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cavitating malignancy
primary bronchogenic carcinoma (especially squamous cell carcinoma)
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cavitating pulmonary metastases
squamous cell carcinoma
adenocarcinoma, e.g. gastrointestinal tract, breast
sarcoma
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infection
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the association of centrilobular micronodules and multiple pulmonary cavities is highly suggestive of the diagnosis
predilection for the upper zones
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pulmonary bacterial abscess/cavitating pneumonia
contains a gas-fluid level
post-pneumonic pneumatocele: a thin walled pneumatocele is not really a cavity but when infected can be thick-walled
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predilection for peripheral and lower zones
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other rare infections
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non-infective granuloma
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vascular
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trauma
pneumatoceles (a thin-walled pneumatocele is not really a cavity)
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congenital (not true "cavity")
A helpful mnemonic is CAVITY.
Radiologic findings
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 infection 11.
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