Chronic cavitary lung disease is an uncommon manifestation of pulmonary infection, and is a pattern which worldwide is most commonly caused by reactivation tuberculosis. Other organisms, however, can cause similar radiologic patterns. Endemic fungi have long been recognized as potential causes of this pattern in North and South America, but the frequency with which these diseases present with chronic cavities in North America is relatively small. Nontuberculous mycobacteria and chronic aspergillus infections are recognized with increasing frequency as causes of this pattern. Melioidosis, a bacterial infection that can also cause chronic lung cavities, was previously understood to be relevant primarily in Southeast Asia, but is now understood to have a wider geographic range. While cultures, serologies, and other laboratory methods are key to identifying the infectious causes of chronic lung cavities, radiologic evaluation can contribute to the diagnosis. Differentiating the radiologic patterns of these diseases from reactivation tuberculosis depends on subtle differences in imaging findings and, in some cases, appreciation of underlying lung disease.
*Department of Radiology, University of New Mexico, Albuquerque, NM
†Royal Darwin Hospital and Menzies School of Health Research, Darwin, NT, Australia
§Department of Medicine, University of Colorado Denver, Aurora
∥Pulmonary Section, Denver Veterans Affairs Medical Center
‡Division of Mycobacterial and Respiratory Infections
¶Department of Medicine
#Program in Cell Biology, National Jewish Health
**Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver Anschutz Medical Campus, Denver, CO
The authors declare no conflicts of interest.
Correspondence to: Loren Ketai, MD, Department of Radiology, MSC10 5530, 1 University of New Mexico, Albuquerque, NM 87131-0001 (e-mail: firstname.lastname@example.org).