Solitary lung cavities on CT imaging: Differentiating malignant and nonmalignant diseases

This study aims to investigate the contribution of radiological findings in differentiating benign from malignant diseases in patients with solitary cavitary lesions detected on computed tomography (CT). In this study, lesion size, cavity wall thickness, and the presence of additional parenchymal findings were retrospectively evaluated to distinguish between benign and malignant diseases and examine the etiology of solitary pulmonary cavities. CT scans were reviewed by a radiologist specialized in thoracic radiology. The study was conducted using a 64-multidetector CT system, and measurements of lesion size and cavity wall thickness were recorded on axial images. The presence of consolidation and centrilobular nodules was also assessed. Receiver operating characteristic curves were generated to determine optimal cutoff points for distinguishing benign from malignant lesions based on cavity wall thickness. Benign lesions accounted for 47.9% of the cases, with active pulmonary tuberculosis being the most common diagnosis. In the malignant group, primary lung cancer predominated, with squamous cell carcinoma being the most frequent subtype. There were significant differences between benign and malignant cases regarding the mean maximum wall thickness and lesion diameter. Additionally, the presence of consolidation and centrilobular nodules was assessed. Maximum wall thickness thresholds of 7.2 mm and 23 mm were found to be the most accurate indicators of benign and malignant etiologies, respectively. In conclusion, CT findings revealed significant differences between malignant and benign solitary pulmonary cavities; benign lesions generally presented with smaller and thinner cavity walls, and perilesional parenchymal findings were observed in benign lesions of infectious origin but not in malignant lesions.