Solitary pulmonary cavity work-up
Recommended: CT Chest with IV contrast is the preferred imaging study for solitary pulmonary cavity work-up. Differential by wall thickness (Woodring criteria): < 5 mm benign (~95%), > 15 mm malignant (~84%); intermediate (5–15 mm) is indeterminate.
Recommended study
CT Chest with IV contrast
Differential by wall thickness (Woodring criteria): < 5 mm benign (~95%), > 15 mm malignant (~84%); intermediate (5–15 mm) is indeterminate. Etiologies: malignancy (squamous), abscess, TB, fungal, septic emboli, vasculitis (GPA), Rasmussen aneurysm.
If the default doesn't apply
Active hemoptysis with cavity
CT
CTA Chest (Rasmussen aneurysm)
IV contrast
Watch-outs
Mycobacterial / fungal in immunocompromised
TB, MAC, aspergilloma — appropriate sampling (BAL, biopsy) and isolation precautions.
Pearls
- Air-fluid level + thick walls → abscess.
- Crescent of air around solid mass → aspergilloma (fungal ball in pre-existing cavity).
- Bilateral cavities + nasal involvement → granulomatosis with polyangiitis.