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Radiology of Chronic Cavitary Infections
Loren Ketai1, Bart J Currie2, Michael R Holt3,4
1Department of Radiology, University of New Mexico, Albuquerque, NM.
Abstract:
Chronic cavitary lung disease is an uncommon manifestation of pulmonary infection, and is a pattern which worldwide is most commonly caused by reactivation tuberculosis. Other organisms, however, can cause similar radiologic patterns. Endemic fungi have long been recognized as potential causes of this pattern in North and South America, but the frequency with which these diseases present with chronic cavities in North America is relatively small. Nontuberculous mycobacteria and chronic aspergillus infections are recognized with increasing frequency as causes of this pattern. Melioidosis, a bacterial infection that can also cause chronic lung cavities, was previously understood to be relevant primarily in Southeast Asia, but is now understood to have a wider geographic range. While cultures, serologies, and other laboratory methods are key to identifying the infectious causes of chronic lung cavities, radiologic evaluation can contribute to the diagnosis. Differentiating the radiologic patterns of these diseases from reactivation tuberculosis depends on subtle differences in imaging findings and, in some cases, appreciation of underlying lung disease.
Insights
Chronic cavitary lung disease, often caused by tuberculosis, can also stem from endemic fungi, nontuberculous mycobacteria, Aspergillus, and Melioidosis. Radiologic evaluation aids in differentiating these infectious causes from tuberculosis.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Radiology
Background:
- Chronic cavitary lung disease is an uncommon pulmonary infection pattern.
- Tuberculosis is the most common worldwide cause, but other pathogens can mimic its presentation.
- Geographic ranges of some causative agents, like Melioidosis, are wider than previously thought.
Purpose of the Study:
- To review the diverse infectious etiologies of chronic cavitary lung disease.
- To highlight radiologic findings that can help differentiate these conditions.
- To emphasize the importance of considering non-tuberculous causes in endemic and non-endemic regions.
Main Methods:
- Literature review of infectious causes of chronic lung cavities.
- Analysis of radiologic patterns associated with various pathogens.
- Comparison of imaging findings to differentiate from tuberculosis.
Main Results:
- Endemic fungi, nontuberculous mycobacteria, chronic Aspergillus infections, and Melioidosis can all cause chronic cavitary lung disease.
- Radiologic evaluation, alongside laboratory methods, is crucial for diagnosis.
- Subtle imaging differences and underlying lung disease can aid in distinguishing causes.
Conclusions:
- Chronic cavitary lung disease has multiple infectious etiologies beyond tuberculosis.
- Radiology plays a supportive role in diagnosis by identifying characteristic patterns.
- Awareness of diverse pathogens and their geographic distribution is essential for accurate diagnosis and management.
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