Thursday, February 26, 2009

Day #231 - Cavitary Lung Lesions


Today we discussed an immunosuppressed patient with bilateral upper lobe cavitary lung lesions. The differential diagnosis for such lesions in the immunocompetent includes:








Infection:
  • TB or Atypical Mycobacterial Disease
  • Cavitary Pneumonia
    • Gram negatives (Klebsiella, E. Coli, Pseudomonas)
    • Gram positives (Staphylococcus aureus (particularly CA-MRSA), group A streptococci)
    • Anaerobes (Lung Abscess)
  • Fungal: Aspergillosis, Histoplasmosis, Coccidiomycosis, Blastomycosis, Cryptococcus
  • PCP
  • Superinfection/Colonization of an existing cavity
  • Septic pulmonary emboli with cavitation
Inflammatory:
  • Wegner's Granulomatosis
  • Rheumatoid Arthritis
  • Sarcoidosis (rare)
Vascular
  • Pulmonary Infarct
Malignancy:
  • Bronchoalveolar carcinoma
  • Bronchogenic carcinoma
  • Squamous cell cancer of lung
  • Cavitating metastases
Anotomical:
  • Cystic Bronchiectasis

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