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肺空洞性病变:引人入胜的视觉综述。

Pulmonary cavitary lesions: a captivating visual review.

作者信息

Nunes Andreia Guimarães, Rodrigues Márcio Cunha, Carneiro Carolina, Costa Ana Catarina

机构信息

Radiology Department, Local Health Unit (ULS) Braga, Braga, Portugal.

出版信息

J Thorac Dis. 2025 Aug 31;17(8):6296-6308. doi: 10.21037/jtd-2025-235. Epub 2025 Aug 28.

Abstract

Cavitary lung lesions represent a frequent yet challenging finding in thoracic imaging, encompassing a wide range of potential etiologies, including infectious, neoplastic, and inflammatory processes. Accurate diagnosis is essential, as treatment and prognosis vary significantly depending on the underlying cause. This pictorial review aims to provide clinicians, radiologists, and pulmonologists with a comprehensive visual guide to the evaluation of cavitary pulmonary lesions. By presenting a series of carefully selected imaging cases, we highlight characteristic radiological features that help narrow the differential diagnosis and suggest the most likely etiology. We emphasize the importance of integrating imaging findings with clinical history, laboratory data, and follow-up studies to enhance diagnostic accuracy. Specific patterns, such as wall thickness, presence of surrounding consolidation or nodules, air-fluid levels, and lesion distribution, are discussed as critical elements in distinguishing between causes such as tuberculosis, fungal infections, primary lung cancer, metastases, and autoimmune conditions. Furthermore, we discuss common pitfalls and overlapping appearances that may lead to misinterpretation, particularly in immunocompromised patients or in regions with endemic infections. This review also reinforces the value of multidisciplinary collaboration in complex cases, where input from radiology, pulmonology, infectious disease, and pathology can be vital for reaching a definitive diagnosis and guiding appropriate management. By synthesizing visual cues and clinical context, this article aims to enhance the diagnostic confidence of healthcare professionals and ultimately improve patient care outcomes when dealing with cavitary lung lesions.

摘要

肺空洞性病变是胸部影像学中常见但具有挑战性的发现,其潜在病因广泛,包括感染性、肿瘤性和炎症性病变。准确的诊断至关重要,因为治疗和预后会因潜在病因的不同而有显著差异。本图文综述旨在为临床医生、放射科医生和肺科医生提供一份全面的可视化指南,用于评估肺空洞性病变。通过展示一系列精心挑选的影像学病例,我们突出了有助于缩小鉴别诊断范围并提示最可能病因的特征性放射学表现。我们强调将影像学表现与临床病史、实验室数据及随访研究相结合以提高诊断准确性的重要性。诸如壁厚、周围实变或结节的存在、气液平面及病变分布等特定模式,被作为区分结核病、真菌感染、原发性肺癌、转移瘤及自身免疫性疾病等病因的关键要素进行讨论。此外,我们还讨论了可能导致误诊的常见陷阱和重叠表现,尤其是在免疫功能低下患者或地方感染流行地区。本综述还强化了多学科协作在复杂病例中的价值,在这些病例中,放射科、肺科、传染病科和病理科的意见对于做出明确诊断及指导恰当治疗至关重要。通过综合视觉线索和临床背景,本文旨在增强医护人员的诊断信心,并最终改善处理肺空洞性病变时的患者护理结局。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5a32/12433063/4a481ab189c2/jtd-17-08-6296-f1.jpg

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