Etiological profile of excavated pulmonary opacities: about 168 cases

The discovery of excavated pulmonary opacities is a frequent occurrence in pneumology and radiology. The etiologies are very varied: infectious, inflammatory, neoplastic, vascular and congenital, hence the difficulty of their diagnostic and sometimes therapeutic management. We conducted a retrospective study of 168 cases collected at the respiratory diseases department of CHU Ibn Rochd in Casablanca over a period from January 2011 to January 2023. The average age was 51, with a clear male predominance (86%). Past history was dominated by active smoking in 54% of cases, tuberculosis in 34% and diabetes in 21%. The average consultation time was 3 months. The clinical picture was progressive in 98% of cases, dominated by bronchial syndrome (87%), hemoptysis (56%), and altered general condition (83%). Chest radiography revealed a single excavated opacity in 75% of cases, and multiple opacities in 16%. Chest CT scans revealed a tumoral process in 56% of cases, alveolar condensation in 29% and superinfected emphysema bullae in 18%. Etiologies were dominated by tuberculosis in 41% of cases and bronchial carcinoma in 29%. Lung abscess was found in 10% of cases, aspergillary transplantation in 9%, superinfected tuberculosis sequelae in 5%, 4 cases of ruptured hydatid cysts, pulmonary staphylococcal disease in one case and pulmonary determination of granulomatosis with polyangiitis in 5 cases. This study highlights the clinical and etiological polymorphism of excavated lung opacities, which remain dominated by tuberculosis and lung cancer in our context.