Today we discussed an immunosuppressed patient with bilateral upper lobe cavitary lung lesions. The differential diagnosis for such lesions in the immunocompetent includes:
Infection:
- TB or Atypical Mycobacterial Disease
- Cavitary Pneumonia
- Gram negatives (Klebsiella, E. Coli, Pseudomonas)
- Gram positives (Staphylococcus aureus (particularly CA-MRSA), group A streptococci)
- Anaerobes (Lung Abscess)
- Fungal: Aspergillosis, Histoplasmosis, Coccidiomycosis, Blastomycosis, Cryptococcus
- PCP
- Superinfection/Colonization of an existing cavity
- Aspergilloma ("fungus ball" or mycetoma)
- Septic pulmonary emboli with cavitation
- Wegner's Granulomatosis
- Rheumatoid Arthritis
- Sarcoidosis (rare)
- Pulmonary Infarct
- Bronchoalveolar carcinoma
- Bronchogenic carcinoma
- Squamous cell cancer of lung
- Cavitating metastases
- Cystic Bronchiectasis
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