Lung Cavitatory Lesion Differential Diagnosis
The following is a differential diagnosis for a lung cavitatory lesion, categorized for clarity and emphasis on critical considerations.
Single Most Likely Diagnosis
- Pulmonary Tuberculosis (TB): This is often the most common cause of lung cavitatory lesions, especially in endemic areas. TB can cause caseating granulomas that lead to cavitation, particularly in the upper lobes of the lungs.
Other Likely Diagnoses
- Pneumonia (especially Staphylococcus aureus, Klebsiella pneumoniae, or anaerobic bacteria): Certain types of bacterial pneumonia can lead to lung abscesses or cavitation, particularly if the infection is severe or if there is a delay in treatment.
- Lung Cancer: Cavitation can occur in lung tumors, especially squamous cell carcinoma. This is more common in central tumors.
- Wegener's Granulomatosis (Granulomatosis with Polyangiitis, GPA): This autoimmune disease can cause necrotizing granulomatous inflammation of the lungs, leading to cavitation.
- Fungal Infections (e.g., Aspergillosis, Histoplasmosis): In immunocompromised patients, fungal infections can cause lung cavitation.
Do Not Miss Diagnoses
- Pulmonary Embolism with Infarction: Although less common, a pulmonary embolism can lead to lung infarction, which may cavitate. This condition is critical and requires immediate attention.
- Septic Emboli: These can occur in the setting of endocarditis or other sources of bacteremia and can lead to multiple lung cavitations.
- Anthrax: In endemic areas or in cases of bioterrorism, inhalational anthrax can cause a severe pneumonia with mediastinitis and can be associated with cavitation.
Rare Diagnoses
- Rheumatoid Nodules: In patients with rheumatoid arthritis, lung nodules can form and occasionally cavitate.
- Eosinophilic Granuloma (Langerhans Cell Histiocytosis): This rare condition can cause lung cysts and nodules, which may cavitate.
- Cystic Lung Diseases (e.g., Lymphangioleiomyomatosis): These conditions can lead to the formation of lung cysts, which may appear similar to cavitation on imaging.
- Parasitic Infections (e.g., Paragonimiasis): Certain parasitic infections can cause lung cavitation, especially in travelers to or residents of endemic areas.