title: Cystic Lung Diseases: Algorithmic Approach.
abstract: Cysts are commonly seen on CT scans of the lungs, and diagnosis can be challenging. Clinical and radiographic features combined with a multidisciplinary approach may help differentiate among various disease entities, allowing correct diagnosis. It is important to distinguish cysts from cavities because they each have distinct etiologies and associated clinical disorders. Conditions such as emphysema, and cystic bronchiectasis may also mimic cystic disease. A simplified classification of cysts is proposed. Cysts can occur in greater profusion in the subpleural areas, when they typically represent paraseptal emphysema, bullae, or honeycombing. Cysts that are present in the lung parenchyma but away from subpleural areas may be present without any other abnormalities on high-resolution CT scans. These are further categorized into solitary or multifocal/diffuse cysts. Solitary cysts may be incidentally discovered and may be an age related phenomenon or may be a remnant of prior trauma or infection. Multifocal/diffuse cysts can occur with lymphoid interstitial pneumonia, Birt-Hogg-Dubé syndrome, tracheobronchial papillomatosis, or primary and metastatic cancers. Multifocal/diffuse cysts may be associated with nodules (lymphoid interstitial pneumonia, light-chain deposition disease, amyloidosis, and Langerhans cell histiocytosis) or with ground-glass opacities (Pneumocystis jirovecii pneumonia and desquamative interstitial pneumonia). Using the results of the high-resolution CT scans as a starting point, and incorporating the patient's clinical history, physical examination, and laboratory findings, is likely to narrow the differential diagnosis of cystic lesions considerably.
authors.affiliation: Pulmonary Division, Lenox Hill Hospital. Electronic address: suhailraoof@gmail.com.
authors.forename: Suhail
authors.initials: S
authors.lastname: Raoof
authors.affiliation: Pulmonary Division, Lourdes Hospital.
authors.forename: Praveen
authors.initials: P
authors.lastname: Bondalapati
authors.affiliation: Pulmonary Critical Care Division, Lenox Hill Hospital.
authors.forename: Ravikanth
authors.initials: R
authors.lastname: Vydyula
authors.affiliation: Pulmonary/CCM, Mayo Clinic.
authors.forename: Jay H
authors.initials: JH
authors.lastname: Ryu
authors.affiliation: Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati.
authors.forename: Nishant
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Department of Radiology, Jamaica Hospital.
authors.forename: Sabiha
authors.initials: S
authors.lastname: Raoof
authors.affiliation: Department of Radiology, University of Maryland.
authors.forename: Jeff
authors.initials: J
authors.lastname: Galvin
authors.affiliation: Pulmonary, Critical Care and Sleep Medicine, North Shore University Hospital.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Rosen
authors.affiliation: Department of Radiology, National Jewish Health.
authors.forename: David
authors.initials: D
authors.lastname: Lynch
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center.
authors.forename: William
authors.initials: W
authors.lastname: Travis
authors.affiliation: Pulmonary Division, Lilavati Hospital.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Department of Thoracic Surgery, Lenox Hill Hospital, Northwell Health.
authors.forename: Richard
authors.initials: R
authors.lastname: Lazzaro
authors.affiliation: Department of Radiology, NYU-Langone Medical Center.
authors.forename: David
authors.initials: D
authors.lastname: Naidich
mesh_terms: D000465:Algorithms; D000686:Amyloidosis / Q000000981:diagnostic imaging / Q000473:pathology; D001706:Biopsy; D058249:Birt-Hogg-Dube Syndrome / Q000000981:diagnostic imaging / Q000473:pathology; D001984:Bronchial Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D001987:Bronchiectasis / Q000000981:diagnostic imaging / Q000473:pathology; D003560:Cysts / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D006646:Histiocytosis, Langerhans-Cell / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D010212:Papilloma / Q000000981:diagnostic imaging / Q000473:pathology; D011020:Pneumonia, Pneumocystis / Q000000981:diagnostic imaging / Q000473:pathology; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014134:Tracheal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology
keywords: cystic lung disease; diffuse lung disease; focal lung luciencies; lung cysts; pulmonary cysts