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Table 1: Cysts and cyst-like lesions based on the mechanism of cyst .

Mechanism of
Principal Associated
cyst Other features
pathophysiology diseases
formation

LAM [11]
Lymphoid
Interstitial
pneumonia [17,
19, 20] Generally thin-walled (<4 mm)3, uniform
PLCH [29] in size, and rounded in shape. May change
Ball valve effect RB-ILD [7, 16] size depending on phase of respiration due
Cystic
due to proximal DIP [25] to communication with airways [5];
dilatation of
obstruction by P. jirovecii [26] in ltration/nodules may be observed
lung
peribronchiolar Primary either radiologically or histopathologically
structures
in ltration neoplasms proximal to cysts. May be diffuse (as in
Endobronchial LAM, PLCH, and LIP) [6, 17] or focal (as
neoplasms in solitary neoplasms) [18, 56].
Metastasis or
micrometastases
Lymphoma [25]

Honeycombing
UIP/IPF [7]
Collagen vascular
disorders,
Air spaces are clustered to resemble a
asbestosis,
honeycomb. Cysts are associated with
Traction hypersensitive
other features indicating brosis including
Cystic bronchiolectasis pneumonitis, and
architectural distortion, interstitial
dilatation of or alveolar ectasia drug induced
thickening, and traction bronchiectasis.
lung due to retraction brosis [56]
Granuloma induced brosis in PLCH
structures from surrounding PLCH [29]
results in irregular shaped cysts when
interstitial brosis Viral bronchiolitis
compared to the more uniform shaped
[5]
cysts as in LAM.
Follicular
bronchiolitis [17]
Lymphoma [25]

Cystic Cystic Chronic infections, Air spaces can be confused for cysts when
dilatation of bronchiectatic air immunode ciency viewed “en face.” e bronchi have thick
lung spaces formed due disorders, genetic walls and do not taper when followed to
structures to brosing syndromes, and the periphery. Cysts are more central than
dilatation of the bullae and may contain uid and change
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bronchi as a result cystic brosis [5, size with phase of respiration due to
of suppurative 31] communication with airways [5].
and/or
necrotizing
in ammation

Abscesses (bacterial ick-walled (>4 mm) with irregular

and amoebic) [45] margins seen as low areas of attenuation
Fungal infections, within an area of pulmonary consolidation
Parenchymal Suppurative nontuberculous
necrosis necrosis mycobacterial or nodule on CT3. Air uid levels present
infections [52] due to superimposed infection. May be
Postinfectious thin-walled in resolved consolidations as
pneumatoceles [46] seen in pneumatoceles [46].

Tuberculosis, ick-walled cavitations with irregular

cryptococcosis, margins predominantly in upper lobes;
Parenchymal
Caseous necrosis coccidioidomycosis, NTM cavitations more thin-walled and
necrosis
and commonly associated with bronchiectasis
histoplasmosis [51] [40, 52, 80].

Pulmonary
infarcts
Vasculitides [54]
Multiple or solitary thick-walled
Parenchymal Amyloidosis [33]
Ischemic necrosis cavitations depending on the extent of
necrosis
involvement.
Rheumatic
disorders [53]
PLCH

Parenchymal Desquamation of Malignancies Cavities are typically thick-walled and are

necrosis tumor tissue with usually found in an area of mass or nodule,
subsequent Squamous cell multifocal or solitary. Very rarely thin-
liquefaction carcinoma [56], walled indicating formation by other
adenocarcinoma mechanisms and can present as a
[18, 81] diagnostic pitfall [83].
Secondary
pulmonary
lymphoma, AIDS
lymphoma [17]
Metastasis
Mesenchymal
sarcomas [58, 59],
epithelial
carcinomas [60,
82], and

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airway
papillomatosis [61]

Emphysematous
Alveolar bullae COPD,
dissolution from connective tissue
Alveolar Blebs and bullae have imperceptible walls
ischemia or syndromes (e.g.,
rupture (<1 mm). Tend to be peripheral and do not
alveolar rupture EDS [69])Later
and/or communicate with airways [5]. Bizarre
and further stages of MCLD
con uence of large cysts are seen in later stages due to
con ation including PLCH,
air spaces con uence of cystic air spaces [29].
resulting in large amyloidosis
air spaces BHD syndrome
[68]

Cystic Parasitic cysts

expansion Echinococcosis [42]
Parasitic cysts See description in Sections 2 and 3.
with lung Paragonimiasis
displacement [43]

Cystic Congenital cyst CPAM

expansion formations Bronchogenic cyst Cysts may present very similar to acquired
with lung manifesting in [75] cystic lesions.
displacement adults Sequestration [73]

Lucite plombage
[5]
Iatrogenic Apical distribution, in resistant
Traumatic
herniation of the tuberculosis.
Miscellaneous diaphragmatic
bowel into Herniation of abdominal structures into
rupture [84]
the thorax the thorax, with a cystic appearance on CT.
Bochdalek hernia
[85]

Diseases whose cystic formation is predominated by the particular mechanism are written in italics.
Different mechanisms involved in cyst formation including bronchiolectasis and cavitary necrosis of
nodules in early stages with con uence of air spaces in end stages of disease. Various mechanisms
proposed for cysts in amyloidosis including air trapping, ischemia by amyloid deposits on vascular
walls, and bronchiolectasis. Majority of the solitary/multifocal neoplastic cavitations are due to
squamous cell neoplasms and rarely due to adenocarcinomas. Rarely reported in adult lymphomas
from check valve and traction brosis.
MCLD: multiple cystic lung disorder; IPF: idiopathic pulmonary brosis; LIP: lymphocytic interstitial
pneumonia; LAM: lymphangioleiomyomatosis; PLCH: pulmonary Langerhans cell histiocytosis; HRCT:
high-resolution CT scan; DIP: desquamative interstitial pneumonia; RB-ILD: respiratory bronchiolitis
interstitial lung disorder; OP: organizing pneumonia.

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