Jacobi Weekly Image 0805-0806

24M from Albania no PMH, move to US * 2 years, present with cough * 2 months, right post upper back pain, night sweats, poor appetite for months

Found to have RLL cavity 6.5 x 5 x 6 cm with scattered nodular, tree and bud capacities

What is the differential diagnosis ?

answer

Mnemonic C-A-V-I-T-Y

C: cancer
- bronchogenic carcinoma: most frequently SCC
- cavitatory pulmonary metastasis(es): again most frequently SCC
A: autoimmune; granulomas from
- Wegener’s granulomatosis (granulomatosis with polyangiitis)
- rheumatoid arthritis (rheumatoid nodules) etc.
V: vascular (both bland and septic pulmonary embolus)
I: infection (bacterial/fungal)
- pulmonary abscess
- pulmonary tuberculosis
T: trauma – pneumatocoeles
Y: youth
- CPAM (congenital pulmonary airway malformation)
- pulmonary sequestration
- bronchogenic cyst

from: https://radiopaedia.org/articles/pulmonary-cavity-mnemonic

Characteristics of Lung Cavities:
Thin < 4mm more likely to be related to infection or rheumatic disease
Thick > 4mm, with areas of necrosis more likely to be related to malignancy