Unmasking the shadows: Right upper lobe cavitating mass with hilar overlay: Two faces, multiple etiologies

ABSTRACT Right upper lobe (RUL) cavitating masses with hilar overlay are diagnostically challenging, as they can result from a spectrum of infectious, neoplastic, or inflammatory etiologies. Misdiagnosis can delay appropriate management, especially in high-risk patients. We present two cases with RUL cavitating masses extending to the hilum and chest wall. The first case involved a 43-year-old male smoker with uncontrolled diabetes presenting with recurrent hemoptysis and dry cough. Initially treated empirically for pulmonary tuberculosis, he showed radiological worsening. Computed tomography imaging revealed consolidation with cavitation and a “Reverse Halo Sign.” Bronchoscopic biopsy confirmed invasive pulmonary mucormycosis. The second case involved a 73-year-old male with long-standing asthma presenting with persistent cough, shortness of breath, and unexplained weight loss. Imaging revealed a cavitating RUL mass with luminal narrowing. Bronchoscopic biopsy confirmed moderately differentiated squamous cell carcinoma. These cases illustrate the diagnostic complexity of cavitating RUL masses and emphasize the importance of integrating clinical history, imaging findings, and histopathological confirmation. Pulmonary mucormycosis is associated with immunocompromised states such as diabetes, whereas chronic airway inflammation, smoking history, and environmental exposures can contribute to lung cancer risk in patients with asthma. Comprehensive evaluation using multimodal imaging, bronchoscopy, and histopathology is essential for accurate diagnosis of cavitating RUL masses. Awareness of risk factors and atypical presentations can guide timely and appropriate management, potentially improving patient outcomes.