Iraqi Postgraduate Medical Journal

Abstract

ABSCTRACT:
BACKGROUND:‎ ‎
The term cavity is a gas-filled space that appears on imaging as ‎an area of low attenuation surrounded by a variously thickened wall within a pulmonary consolidation, mass, or nodule. ‎Multidetector computed tomography (CT) of the chest is the current technique ‎of choice for evaluating lung cavities.‎
OBJECTIVE:
To assess the role of some computed tomography criteria in ‎differentiating benign ‎from malignant solitary cavitary lung lesion.‎
PATIENT AND METHODS:
This was a cross sectional study done in the Computed Tomography ‎unit of Al-Immamain Al-‎Kadhmain Medical city in Baghdad, Iraq between ‎October, ‎‎2016 and June, 2017. All patients presented with solitary pulmonary cavitary lesions ‎‎detected by chest x-ray referred for different reasons. ‎‎Examination of ‎the chest was ‎performed by multi-detector CT (Somatom definition edge, SIEMENS ‎‎medical system, Germany (256 slices)) with 2 sets of CT examination one ‎before and another ‎after giving IV nonionic iodinated contrast ‎medium (Ultravist 370 mg /ml), 1.5 ml/kg Body ‎weight. ‎The final diagnosis was obtained depending on the sputum ‎culture for AFB, ‎bronchoscopy and biopsy, bronchoscopy and brush ‎cytology and true cut biopsy. ‎
RESULTS:
The study included 50 patients with solitary pulmonary ‎cavitary lesions, 54% were male and 46% were females. Final diagnosis was 80% diagnosed as ‎benign and 20% as malignant lesions. Enhancement was ‎significant among 20% of studied patients. The common associated CT scan ‎features were pleural effusion (24%), consolidation (12%), consolidation and tree ‎in Bud (10%), pleural effusion and mediastinal lymph nodes (8%), tree in bud ‎‎(10%), mediastinal lymph node and consolidation (8%), ground glass opacification, ‎honeycombing and tree in bud (6%), pleural effusion and tree in bud (4%), fibrosis ‎‎(2%) and encysted hydro-pneumothorax (2%). There was a highly significant association of significant enhancement and ‎ Pleural effusion ‎ with malignant solitary cavitary lesions (p<0.001 and p=0.003‎). A highly significant ‎association was observed between increased mean thickness of lesion and ‎malignant solitary cavitary lesion (p<0.001) ‎
CONCLUSION: ‎
The common computerized tomography characteristics of malignant solitary ‎pulmonary cavitary lesions were significant enhancement, pleural effusion and ‎increased diameter and thickness of pulmonary cavities.‎