Tuberculosis (TB): Typically affects the upper lobes, especially in post-primary or reactivation TB, due to higher oxygen tension in these regions.
Aspergillosis: Aspergillomas (fungal balls) often form in pre-existing cavities in the upper lobes, especially in patients with prior TB or sarcoidosis.
Squamous Cell Carcinoma: A primary lung cancer that commonly cavitates, often found in the upper lobes.
Sarcoidosis: Chronic sarcoidosis can sometimes lead to cavitary lesions, often in the upper lobes.
Histoplasmosis: Chronic pulmonary histoplasmosis can present with cavitary lesions in the upper lobes.
2. Lower Lobe Cavities
Lung Abscess: Aspiration pneumonia typically affects the lower lobes, which may lead to lung abscess formation.
Wegener’s Granulomatosis (Granulomatosis with Polyangiitis): Cavitary nodules can occur in any lobe, but lower lobe involvement is common.
Septic Pulmonary Embolism: Cavities resulting from septic emboli may preferentially affect the lower lobes due to gravity-dependent blood flow.
Rheumatoid Nodules: Rheumatoid arthritis-associated lung disease may show cavitation in nodules, which can involve any lobe, but lower lobe predominance is noted.
3. Cavities in Both Upper and Lower Lobes
Lung Abscess (due to Aspiration): While aspiration usually affects the lower lobes, it can also affect the upper lobes (particularly in the posterior segments) if the patient is lying down at the time of aspiration.
Fungal Infections: Cavitary lesions due to endemic fungal infections (e.g., histoplasmosis, coccidioidomycosis) can be found in both upper and lower lobes, although chronic infections may favor the upper lobes.
4. Middle Lobe and Lingula Cavities
Less common: The middle lobe and lingula are less frequently involved in cavitary lesions. However, infections such as TB and fungal infections may occasionally affect these regions.
5. Diffuse Cavities (Multiple Lobes)
Septic Emboli: Septic emboli can lead to multiple cavitary lesions throughout both lungs.
Pulmonary Vasculitis (e.g., Granulomatosis with Polyangiitis): Can cause multiple cavitary nodules affecting multiple lobes.
Metastatic Lung Disease: Cancers such as squamous cell carcinoma from distant sites can metastasize to the lungs, causing cavitary lesions in multiple lobes.
Pneumocystis Jiroveci Pneumonia (PCP): In HIV/AIDS patients, PCP can cause widespread cavitation, particularly in severe cases.
