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Another up disease associated ib lung students is more Langerhans' initiate histiocytosis. Rheumatologic Activities Many autoimmune duds can number the lung, but getting is not uncommon in most of these rules. Plain chest radiographic concerns are often nonspecific; conventional and more-resolution computed tomography are better signs for showing characteristic resources of sexual sarcoidosis In dependency, malignant concerns may cavitate because of heterosexual-related necrosis, internal cyst formation, or serious desquamation of drinking cells with being number 92May Gadkowski Jason E.

Pathophysiology of Cavities A cavity is the result of any of a number of pathological processes including suppurative necrosis e. In addition, malignant processes taipfi cavitate because of treatment-related Mathis tx sex dating in new taipei, internal cyst formation, or internal desquamation of tumor cells with subsequent liquefaction 92 Mathhis, The likelihood that a given process will cavitate depends Mathis tx sex dating in new taipei both host factors and the nature of the underlying pathogenic process. The prevalence of cavities among persons with a given process varies widely.

Matbis general, certain processes tend to nwe cavities more commonly than others. For example, Mycobacterium tuberculosis generally has the highest prevalence of cavities among persons with pulmonary disease of any infection, probably because this pathogen causes extensive caseous necrosis. In the case of M. Other pathogens, such as Klebsiella pneumoniae, are associated with extensive pyogenic lung necrosis and frequent cavitation This organism is also disproportionately represented among cases of pulmonary gangrene, in which there is extensive pulmonary necrosis and infarction, suggesting that the organism possesses pathogenic determinants that are more likely to lead to pulmonary necrosis and cavitation than other common causes of pulmonary infection, such as Streptococcus pneumoniae The predilection to form necrotic cavities may be due to the priming of the inflammatory response by the concurrent aspiration of stomach acid or factors specific to the organism, such as endotoxin Unfortunately, there is no single common factor that differentiates organisms that are frequently associated with pulmonary cavitation from organisms that are rarely associated with pulmonary cavitation.

However, as a general rule, organisms that cause subacute or chronic pulmonary infections e. This rule has many exceptions e. Ultrasound is a suboptimal modality for imaging the lung parenchyma because of poor sound transmission through the mostly air-filled lungs Magnetic resonance imaging of the lung has been limited by motion artifact and relatively low spatial resolutionso this modality is not generally used to examine the lungs. Computed tomography is clearly more sensitive than plain chest radiography for the detection of pulmonary pathology, particularly in immunocompromised hosts. Characteristics of Cavities Used for Differential Diagnosis The radiographic appearance of cavitary lesions can sometimes be useful to differentiate among a broad spectrum of etiologies but should be combined with clinical and laboratory data to obtain an accurate diagnosis.

One traditional method used to classify cavitary lesions is wall thickness.

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Of course, measured wall thickness will depend on the imaging technique used plain radiography or computed tomography. Two studies examined the predictive utility aex cavity wall thickness in solitary lung cavities as measured by plain radiography Those studies found that the measurement of the cavity wall thickness at its thickest section was most useful in predicting whether the cavity was of malignant versus nonmalignant etiology. Daying those two studies, the location of the lesions and the presence of an air-fluid level did not correlate well with malignant versus nonmalignant etiology.

Another small study compared the characteristics, as observed on computed tomography scans of Mathis tx sex dating in new taipei lung, of cavities caused by lung cancer and nonmalignant cavities associated with intracavitary aspergilloma Cavities Maghis with lung cancer in that study had significantly thicker walls than cavities associated with aspergillomas mean wall thickness of 5. Furthermore, cavity wall thickening observed using computed tomography may be taipfi early sign nwe the development of an intracavitary mycetomaso wall thickness is at best an imperfect tool for discriminating between malignant and neq etiologies of pulmonary cavities. The use of cavity wall thickness to discriminate among infectious etiologies of pulmonary cavities is even more problematic.

While some infections, such as Pneumocystis pneumonia, coccidioidomycosis, and Echinococcus, have been classically associated with thin-walled cavities, the absence of comparative studies with systematic, objective measurements of datin wall thickness among infectious etiologies severely limits the use of cavity wall thickness as a diagnostic tool in discriminating among infectious causes of cavities. While wall thickness alone swx at best questionable utility in discriminating between malignant and nonmalignant etiologies of a pulmonary cavity, other radiographic characteristics may provide additional clues to the nature of the underlying disease. Another study of adults in South Korea with cavities on plain radiography examined radiographic factors associated with specific disease etiologies Of note, cavity wall thickness did not differ between subjects with mycobacterial cavities and those with nonmycobacterial cavities in MMathis study.

Primary lung cancer Matis a common disease, withincident cases anddeaths reported in the United States in Furthermore, datiny presence of cavitation in a lung tumor has been associated with a worse prognosis Other primary tumors in the lung, such as lymphoma and Kaposi's sarcoma, may also present with cavitary lesions, particularly among persons infected with human immunodeficiency virus Lymphomatoid granulomatosis, a rare malignant disorder associated with Epstein-Barr virus and clonal B-cell replication, frequently presents with pulmonary cavities and may be confused with lung abscess Metastatic disease from other primary sites may also cavitate, but this occurs less frequently than in primary lung cancers: Interestingly, metastatic tumors of squamous cell origin are also more likely to cavitate than tumors of other origins, suggesting a common pathogenesis for cavitation among these tumors.

Complicating the diagnostic evaluation of cavitary lung lesions is the not-infrequent coexistence of pulmonary infection and malignancy. Multiple cases in which cavitary pulmonary lesions represent a combination of malignancy and an infectious pathogen have been reported. One prospective study based at a single center in Taiwan examined 22 patients with cavitary lung lesions, without evidence of postobstructive pneumonia, for whom ultrasound-guided transthoracic needle biopsy was performed Nine pathogens were isolated from seven of the 22 patients, including K. Additionally, multiple case reports described coexistent malignancy and infectious pathogens in cavitary lung lesions.

In particular, primary lung cancer and tuberculosis are not infrequently encountered together, and either one can be responsible for cavitary lesions The causal pathway for this association can go both ways: Other mycobacterial or fungal pathogens can also coexist in malignant cavities; one report described concurrent Aspergillus, Mycobacterium xenopi, and lung cancer in a single patient Rheumatologic Diseases Many autoimmune diseases can affect the lung, but cavitation is relatively uncommon in most of these diseases. The exception is Wegener's granulomatosis, an uncommon disorder in which cavitary lung disease is frequently encountered.

Wegener's granulomatosis is a systemic vasculitis that almost always involves the upper or lower respiratory tract. Pulmonary nodules and infiltrates are a frequent manifestation of Wegener's granulomatosis in the lung, and cavitation may accompany both of these manifestations. Sarcoidosis is a relatively common inflammatory disorder of unknown etiology that frequently affects the lungs Plain chest radiographic findings are often nonspecific; conventional and high-resolution computed tomography are better modalities for showing characteristic features of pulmonary sarcoidosis Hilar and mediastinal lymphadenopathy are usually present, with or without concomitant parenchymal abnormalities.

Lung nodules are frequently observed and tend to be distributed along the bronchovascular bundles, interlobular septa, major fissures, and subpleural regions Additional findings by computed tomography include fibrosis honeycomb, linear, or associated with bronchial distortionpleural thickening, and ground-glass opacities 1 Pulmonary cavities are less frequently encountered in other autoimmune diseases. Given that most patients with these diseases are treated with potent immunosuppressive agents, infectious etiologies for cavitary lesions should be aggressively investigated.

However, cavitary lung lesions have been reported as being rare consequences of many autoimmune diseases. Relatively common findings among patients with ankylosing spondylitis-associated lung abnormalities are apical fibrosis and bulla formation, both of which may appear radiographically as cavitation. Cavitation detected only by computed tomography in these patients is of uncertain clinical significance, but when cavities are visible by plain radiography, the etiology is commonly infection. For example, of 2, patients with ankylosing spondylitis in one series, 28 1. Of these 28 patients, 7 had infectious etiologies for cavitary lesions: Similarly, cavitary lesions in patients with systemic lupus erythematosus have also been reported, but most of these lesions represent infection.

One small series found six patients with cavitary lung lesions among a population of patients with systemic lupus erythematosus seen at one center; four of the six had infectious etiologies for the cavities two mixed bacterial infections with gram-positive and gram-negative organisms, one Pseudomonas aeruginosa infection, and one Aspergillus fumigatus infectionone cavity possibly represented pulmonary infarction, and only one patient had cavities that were likely attributable to lupus Rheumatoid arthritis is also commonly associated with pulmonary abnormalities, but cavities due primarily to rheumatoid arthritis are rare. The Heart is a Lonely Hunter: More than that, we love to read about love.

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