Pulmonary nodules with groundglass opacity ggo are frequently observed and will. A man in his 50s with hemoptysis, dyspnea, and bilateral. The differential diagnosis of multifocal consolidation is wide and can be challenging. To define ground glass opacity ggo and to show how it can be detected on hrct scans for diffuse lung diseases. Ground glass opacity lesions on computed tomography during postoperative surveillance for primary nonsmall cell lung cancer. A pulmonary infiltrate which clears within 2 to 3 days is a common finding in aspiration. I do not know if this type of cell change shows up anywhere else.
The only way to get a definitive diagnosis is to get a biopsy and look at the tissue under the. Eosinophilia in peripheral blood, pulmonary biopsy or bronchoalveolar lavage is common 11, 12. More bronchoscopy high levels of interleukin5 in bal. The left xray shows a much more subtle groundglass appearance while the right xray shows a much more gross groundglass appearance mimicking pulmonary edema. The ct chest findings of patchy groundglass opacity and superimposed septal. On the other hand, the progression of patchy infiltrates accompanied by deterioration in gas exchange suggests the appearance of ards. Patients with early diffuse pulmonary infiltrative diseases are more likely to present with an area of ground glass opacity in the lung. The advent of computed tomography screening for lung cancer will increase the incidence of ground glass opacity ggo nodules detected and referred for diagnostic evaluation and management. Five months after her treatment, she developed fatigue, fever, productive cough, and weight loss. Pulmonary infiltrates are common, as the differential diagnosis includes such prevalent disorders as heart failure and community acquired pneumonia, but specific studies of the epidemiology of. Highresolution ct features include diffuse or patchy groundglass opacity or consolidation, predominantly in dependent lung regions. A 71yearold woman was referred for evaluation of an abnormal ct scan of the chest.
Jul 30, 20 ground glass opacity ggo is a radiological finding in computed tomography ct consisting of a hazy opacity that does not obscure the underlying bronchial structures or pulmonary vessels. Could be lots ground glass is a term that radiologists use to describe the way the lung appears on a ct scan or xray. May 15, 2003 three days later, a ct scan of the chest, obtained without the intravenous administration of contrast material, disclosed multiple peripheral opacities, which were patchy and had a ground glass appearance. The differential diagnosis of newonset pulmonary infiltrates during adjuvant therapy in a cancer patient is challenging. In a patient with acute symptoms, the distribution of ggo is of limited value in helping distinguish among the various possible causes. The chest radiograph demonstrated bilateral, peripheral, patchy consolidations. Groundglass opacity lung nodules in the era of lung cancer. Treatment of symptomatic patients with op is based on oral corticosteroids, and most studies report improvement in lung function with few relapses on steroid. Groundglass opacity ggo is a radiological finding in computed tomography ct consisting of a hazy opacity that does not obscure the underlying bronchial structures or pulmonary vessels. Differential diagnosis and management of focal ground. In the other 2040% of the cases the lung disease is not treatable and the groundglass pattern is. Any individual may develop acute pulmonary infiltrates, but age, demographics, and patient history can significantly help to narrow the differential. Detecting diffuse lung infiltrates on chest radiography is a common clinical problem. Possible causes include pneumocystis carinii pneumonia.
In radiology, ground glass opacity ggo is a nonspecific finding on radiographs and computed. The differential diagnosis of subacute or chronic illness characterized by episodic fever, alveolarinterstitial pulmonary infiltrates, and respiratory failure is depicted in table 6. Differential diagnosis and management of focal groundglass. His chest xray showed bilateral nodular infiltrates figure 1a and a ct of the chest revealed bilateral diffuse ground glass opacities consistent with alveolar haemorrhage figure 1b. It is a nonspecific sign with a wide etiology including infection, chronic interstitial disease and acute alveolar disease. A chest xray showing bilateral nodular infiltrates a. Ground glass opacity is a nonspecific term that refers to the presence of increased hazy opacity within the lungs that is not associated with obscured underlying vessels obscured underlying vessels is known as consolidation. Groundglass opacity is nonspecific, but a highly significant finding since 6080% of patients with groundglass opacity on hrct have an active and potentially treatable lung disease. Depending on your symptoms, your doctor will order more.
To make diagnosis easier, by indicating the findings that narrow down the differential diagnosis. Recent cxr showed bibasilar ground glass infiltrates. The more ct scans that are performed, the more groundglass opacities ggos are seen and what to do with these abnormalities can be difficult to ascertain for clinicians. The diagnosis of eosinophilic pneumonia is based on the presence of pulmonary infiltrates, more frequently of peripheral distribution and in the upper lobes. The patchy infiltrates bilaterally with the right greater than the left containing air bronchograms are characteristic of a bilateral pneumonic process which extends into the alveolar spaces.
The study examines the chest xrays, and ct scans from over 20 patients aged 1074 years, with symptoms of covid19. Check the full list of possible causes and conditions now. Groundglass opacity lesions on computed tomography during. To define groundglass opacity ggo and to show how it can be detected on. In the other 2040% of the cases the lung disease is not treatable and the ground glass pattern is the result of fibrosis. Her medical history was significant for recent diagnosis of leftsided breast cancer treated with breastconserving therapy lumpectomy followed by tangential beam irradiation. Septal thickening and groundglass opacity with a gravitational distribution in a patient. Groundglass opacity lung nodules in the era of lung. Reticulonodular infiltrates on chest radiograph right diagnosis.
Reticulonodular infiltrates on chest radiograph is an abnormal finding in the lungs found on a chest xray that can be caused by a variety of disease, disorders, or condition. Ground glass opacity an overview sciencedirect topics. In radiology, ground glass opacity ggo is a nonspecific finding on computed tomography ct scans that indicates a partial filling of air spaces in the lungs by exudate or transudate, as well as interstitial thickening or partial collapse of lung alveoli. Groundglass opacity is a nonspecific term that refers to the presence of increased hazy opacity within the lungs that is not associated with obscured underlying vessels obscured underlying vessels is known as consolidation.
The presence of marked blood eosinophilia narrows the differential table 1. The differential diagnosis of interstitial pulmonary infiltrates to consider during infections diseases consultations is listed in. Ground glass opacities often represent parenchymal abnormalities below the spatial resolution of highresolution ct of the lung. Chest xray revealed bilateral pulmonary infiltrates. Abnormalities characterized by increased lung opacity can be divided into two categories based upon their attenuation. The scans showed inflamed lungs with ground glass opacities, which look like. Acute bilateral airspace opacification differential. Transbronchial biopsy is especially helpful in sarcoidosis, eosinophilic pneumonia, goodpasture syndrome, and histiocytosis x. His medical history included hypertension, a 35packyear active smoking history, and occupational hydrocarbon exposure as a mechanic in the foresting industry. Miled dependent atelectasis and scarring are noted. Differential diagnosis of pulmonary infiltrate in icu patients.
Mixed bacterial pneumonias must be differ entiated from tuberculosis, carcinoma, and other spe cific mycotic, bacterial, and viral pulmonary infec tions to which they may be secondary. Differential diagnosis between communityacquired pneumonia and nonpneumonia diseases of the chest in the emergency ward. Noninfectious mimics of communityacquired pneumonia. Differential diagnosis of groundglass opacities includes infections. Even though the differential diagnosis for migratory fleeting alveolar infiltrates is broad table 1, its presence in conjunction with reversed halo sign is highly suggestive of op. A practical approach to highresolution ct of diffuse lung.
Clinical information, particularly the duration of symptoms, can limit the diagnosis when either of these findings is present. They concluded that radiological diagnosis of noninvasive lung cancer. Acute bilateral airspace opacification is a subset of the larger differential diagnosis for airspace opacification an exhaustive list of all possible causes of acute bilateral airspace opacities is long, but a useful way to consider the huge list is via the material within the airways. Management includes excluding known causes of cop such as drugs and the rheumatoid diseases. Sep 03, 2016 acute drug reaction with pulmonary edema and diffuse ground glass opacity ggo. Mar 15, 2020 the study examines the chest xrays, and ct scans from over 20 patients aged 1074 years, with symptoms of covid19. Each of these findings tends to be nonspecific and has a long differential diagnosis. Ground glass opacity is a frequent but nonspecific finding on highresolution ct scans of the lung parenchyma.
An exhaustive list of all possible causes of acute bilateral airspace opacities is long, but a useful way to consider the huge list is via the material within the airways. The advent of computed tomography screening for lung cancer will increase the incidence of groundglass opacity ggo nodules detected and referred for diagnostic evaluation and management. Management of the patients with pulmonary infiltrates. There is redemonstration of an illdefined somewhat groundglass opacity in the medial aspect of the right lower lobe which appears slightly more prominent, this is again an adjacent to moderate osteophyte. The patients are often intubated because of severe respiratory distress. Groundglass opacities often represent parenchymal abnormalities below the spatial resolution of highresolution ct of the lung. Differential diagnosis of pulmonary infiltrates in icu patients. Pulmonary infiltrate an overview sciencedirect topics. What are ground glass infiltrates on an xray and what does. A hrct alveolar pattern presents as patchy consolidation andor groundglass opacity, often in association. A ground glass lung result from a ct scan is a nonspecific finding that describes an area characterized by a small increase in lung density, explains the national institutes of health.
The presence of marked blood eosinophilia narrows the differential. Groundglass opacities are the predominant hrct finding with minimal reticular. A man in his 50s presented to the ed with a 3day history of smallvolume hemoptysis and newonset dyspnea. The only way to get a definitive diagnosis is to get a biopsy and. The differential diagnosis of the many causes of ggo includes pulmonary edema, infections including severe acute respiratory syndrome. Fleeting alveolar infiltrates and reversed halo sign. Additional findings in this patient are paraseptal emphysema in the upper lobes and some subtle septal thickening in the basal parts. Based on these nonspecific ct findings there is a broad differential diagnosis and additional clinical information is mandatory for the interpretion of the hrct. Computed tomographic imaging of the chest performed on the same date revealed bilateral, predominantly peripheral, consolidations with air bronchograms and adjacent groundglass opacities. The chest radiograph features of cop are typically bilateral with areas of patchy or diffuse consolidation or ground glass infiltrates.
Inflammation in heart, episode of vtach, small cysts throughout the lungs, patchy ground glass opacity. The differential diagnosis for this patient with patchy bilateral groundglass opacities on chest ct scan includes several infectious and. Differential diagnosis of pulmonary infiltrates in icu. The scan shows basilar multicentric infiltrates with elements of ground glass change and small airway wall thickening red circles in the right lower lobe middle lobe and lingula, as well as interlobular septal thickening green circle in the lateral basal segment of the left lower lobe. It can be caused by a number of things fluid buildup, bruising to the lungs, chronic lung disease, infection, or small airway collapse from laying down too long. Highresolution ct features include diffuse or patchy ground glass opacity or consolidation, predominantly in dependent lung regions. The hrct pattern varies and includes patchy groundglass, crazy paving, elements of consolidation and sometimes nodules. The differential diagnosis of the many causes of ggo includes pulmonary edema, infections including severe acute respiratory syndrome coronavirus 2, cytomegalovirus and pneumocystis jirovecii pneumonia, various noninfectious interstitial lung diseases such as hypersensitivity pneumonitis, hammanrich syndrome, diffuse alveolar hemorrhage, cryptogenic organizing pneumonia, and pulmonary contusion. Ground glass opacificationopacity ggo is a descriptive term referring to an area of increased attenuation in the lung on computed tomography ct with preserved bronchial and vascular markings. Clinically, ards is characterized by respiratory dyspnea and hypoxemia which develop over hours or days. Pure ggos are those with no solid components, whereas partsolid ggos contain both ggo and a solid component. Ground glass opacity respiratory disorders medhelp. Articles hrct pattern recognition and differential. More highresolution ct of chest comparison of supine and prone views may be helpful as the basilar infiltrates due to pulmonary edema may improve in the prone position.
The differential diagnosis of interstitial pulmonary infiltrates to consider during infections diseases consultations is listed in table 6. Groundglass opacity with reticulation radiology key. While there is a wide differential diagnosis for the cap syndrome. Alveolar filling may be due to fluid, cells, or other material which, in most cases, radiology cannot. The evolution of the infiltrates is a great help in establishing the diagnosis.
The dominant pattern is ground glass opacification. Usual interstitial pneumonia manifesting as subpleural patchy areas of reticulation and groundglass opacity without honeycombing cyst in a 62yearold man. Focal pulmonary groundglass opacities ggos can be associated with bronchioloalveolar carcinoma. On hrct consolidated ground glass images may be seen in the periphery and upper lobes.
In a middleaged woman with peripheral opacities on imaging, not resolving with antibiotics, the differential is broad and. To define groundglass opacity ggo and to show how it can be detected on hrct scans for diffuse lung diseases. Four groups were considered in the differential diagnosis of predominant ggo with a diffuse or patchy distribution. Evaluation of persistent pulmonary infiltrate differentials. Groundglass opacification radiology reference article. This pictorial essay illustrates the pathologic basis of groundglass opacity and provides a guide to the differential diagnosis of the disorders that can produce this appearance. A hrct alveolar pattern presents as patchy consolidation andor ground glass opacity, often in association. It can be, and often is, a precusor to lung cancer. The differential diagnosis for this patient with patchy bilateral ground glass opacities on chest ct scan includes several infectious and noninfectious causes. The patients have eosinophilia, and lung changes are seen in approximately half of cases. Notice the overlap in differential diagnosis of perilymphatic nodules and the nodular. A woman with asthma and groundglass opacities annals of the.
The present retrospective study aimed to test the validity of a multistep approach to discriminate malignant from benign localised focal ggos, identifies useful diagnostic features on computed tomography ct, and suggests appropriate management guidelines. Ground glass opacities are the predominant hrct finding with minimal reticular changes that indicate fibrosis. Any pathologic process that fills the alveoli with fluid, pus, blood, cells or protein can result in lobar. Although the differential diagnosis of ground glass opacities at highresolution ct is large, these etiologies may be broadly divided into acute or chronic causes. Ground glass is an appearance on a ct of a cluster of lung cells that have changed. The patient did not have fevers, chills, chest pain, abdominal pain, or changes in urination. Diagnostic approach to the patient with diffuse lung disease. The differential diagnosis for this patient with patchy bilateral groundglass opacities on chest ct scan includes several infectious and noninfectious causes. Assessment of persistent pulmonary infiltrate differentials.
What are ground glass infiltrates on an xray and what. Groundglass opacificationopacity ggo is a descriptive term referring to an area of increased attenuation in the lung on computed tomography ct with preserved bronchial and vascular markings. In typical cases, the diagnosis of measles can usually be made on the basis of clinical signs and symptoms. The left xray shows a much more subtle ground glass appearance while the right xray shows a much more gross ground glass appearance mimicking pulmonary edema. Acute bilateral airspace opacification is a subset of the larger differential diagnosis for airspace opacification. Ground glass opacity is nonspecific, but a highly significant finding since 6080% of patients with ground glass opacity on hrct have an active and potentially treatable lung disease. Annals of the american thoracic society ats journals. Opportunistic infections, pulmonary druginduced toxicity and metastatic dissemination of the underlying cancer are the most common causes.
Broadly speaking, the differential for groundglass opacification can be split into 5. Contribution to the differential diagnosis of pneumonia in childhood. Management of multiple pure ground glass opacity lesions in patients with bronchioloalveolar carcinoma. It can reflect minimal thickening of the septal or alveolar interstitium. A kidney biopsy was performed for further evaluation. Lung hrct basic interpretation the radiology assistant. See detailed information below for a list of 4 causes of reticulonodular infiltrates on chest radiograph. What does a ground glass lung result from a ct scan mean. The picture is very unspecific, and consequently diagnosis is based on a typical triad of small vessel vasculitis, asthma and eosinophilia. Although the differential diagnosis of groundglass opacities at highresolution ct is large, these etiologies may be broadly divided into acute or chronic causes. Focal pulmonary ground glass opacities ggos can be associated with bronchioloalveolar carcinoma. Management of multiple pure groundglass opacity lesions in patients with bronchioloalveolar carcinoma. Three days later, a ct scan of the chest, obtained without the intravenous administration of contrast material, disclosed multiple peripheral opacities, which were patchy and had a groundglass appearance.
919 241 713 51 1376 272 942 25 695 84 379 381 1051 744 753 1418 256 398 78 1431 459 1110 1111 1141 178 631 1174 214 953 1508 708 679 1472 520 1337 31 1063 100 1350 891 381 794 780 1148 958 194 1322