The Role of Some CT Criteria in the Diagnosis of Solitary Pulmonary Cavitary Lesion
Iraqi Postgraduate Medical Journal,
2018, Volume 17, Issue 3, Pages 249-254
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.
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.
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)
The common computerized tomography characteristics of malignant solitary pulmonary cavitary lesions were significant enhancement, pleural effusion and increased diameter and thickness of pulmonary cavities.
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