Case 4
History
51-year-old smoker with weight loss and hemoptysis.
PA view of the chest shows a left upper lobe cavity with
2.0 cm thick irregular wall containing an air fluid level.
Lateral view of the chest again shows a left upper lobe
cavity with a 2.0 cm irregular wall containing an air fluid
level.
Diagnosis
Cavitating Carcinoma.
Findings
Cavitation occurs in two to 16 percent of pulmonary carcinomas. The majority are squamous cell carcinomas. Large cell carcinoma and adenocarcinoma cavitate occasionally. Small cell carcinoma rarely, if ever, cavitates. Pathogenesis of cavitation includes growth of tumors outstripping blood supply with subsequent necrosis and cavitation, as well as cornifications of squamous epithelium with subsequent liquification and evacuation into small airways. There is also an evacuation of central contents or mucin or mucoid degeneration.
There is a predilection for upper lobes, and the cavity wall tends to be thick with an irregular, nodular inner lining. Chunks of necrotic cancer occasionally may become detached and lie free within the cavity, simulating a fungus ball. Cavity formation in carcinoma is of three different types:
- Central necrosis of neoplasm (77 percent)
- A lung abscess distal to an obstructing neoplasm (17 percent)
- Cavitary abscesses elsewhere in the lungs from spillover of purulent material from segmental pneumonitis (6 percent)
