Groundglass opacity in lung metastasis from breast cancer. Although the differential diagnosis of groundglass opacities at highresolution ct is large, these etiologies may be broadly divided into acute or chronic causes. Fibrosis can occur in nonspecific interstitial pneumonia and most often occurs in the lower lobes with associated traction bronchiectasis. Daniel rasband, grant berges, and marc gosselin there are a number of diseases that present with groundglass opacification of the lung as a primary manifestation on chest radiography and thinsection computed tomography ct. Ggo can be observed in both benign and malignant conditions, including lung cancer and its preinvasive lesions. Ground glass opacity an overview sciencedirect topics.
Lung hrct basic interpretation the radiology assistant. A woman with asthma and groundglass opacities annals of the. Imagine construction scaffolding with trash bags filled with air taped to it. 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. Therefore, in the interpretation of cases with ground glass opacities, associated clinical information is often crucial. The longterm course of groundglass opacities detected on thinsection computed tomography. To make diagnosis easier, by indicating the findings that narrow down the differential diagnosis. Focal pulmonary ground glass opacities ggos can be associated with bronchioloalveolar carcinoma.
Pulmonary opacities on chest xray litfl ccc differential. In radiology, ground glass opacity ggo is a nonspecific finding on computed tomography scans ct consisting of a hazy opacity that does not obscure the underlying bronchial structures or pulmonary vessels, 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. Peripheral lung opacities mnemonic dr daniel j bell and dr vinod g maller et al. Groundglass opacity ggo is a radiological finding in computed tomography ct consisting of a hazy opacity that does not obscure the underlying bronchial. Usual interstitial pneumonia manifesting as subpleural patchy areas of reticulation and groundglass opacity without honeycombing cyst in a 62yearold man. The presence of marked blood eosinophilia narrows the differential. His medical history included hypertension, a 35packyear active smoking history, and occupational hydrocarbon exposure as a mechanic in the foresting industry. Mosaic attenuation is also a common finding, and air trapping may be seen on expiratory scans. Ground glass opacity in lungs answers on healthtap. Groundglass opacity is a frequent but nonspecific finding on highresolution ct scans of the lung parenchyma. These are subtle ground glass opacities that are seen around the small airways and are mostly the result of inflammatory process around the respiratory bronchiole. The differential diagnosis for this patient with patchy bilateral ground glass opacities on chest ct scan includes several infectious and noninfectious causes. Consolidation is the radiological term used to describe an area of increased lung density within the air spaces.
Chest imaging appearance of covid19 infection radiology. Ground glass opacity ggo is the descriptive term used to refer to this hazy area. The longterm course of ground glass opacities detected on thinsection computed tomography. Highresolution computed tomography showed diffuse ground glass opacities in bilateral lungs and subpleural patchy consolidations. Groundglass opacity is defined as a nonspecific term referring to the presence on highresolution ct of a hazy increase in lung opacity not associated with obscuration of underlying vessels. The socalled ground glass pulmonary opacity is characterized by a slight. Isolated diffuse groundglass opacity in thoracic ct. To define groundglass opacity ggo and to show how it can be. A woman with asthma and groundglass opacities annals of. Mar 28, 2019 an oslerphile emergency physician and intensivist suffering from a bad case of knowledge dipsosis. Notice the overlap in differential diagnosis of perilymphatic nodules and the nodular. The ct opacities were typically ground glass in density and sometimes spared the subpleural space.
Covid19 patient presenting with initial gastrointestinal. Broadly speaking, the differential for ground glass opacification can be split into 5. I do not know if this type of cell change shows up anywhere else. Ground glass opacities are one of the atypical manifestations, reported as diffuse or patchy illdefined opacities frequently associated with additional findings and interstitial nodules. Keep reading to find out more about ground glass opacities and some specific treatment options. These lesions may be infective, inflammatory, benign tumors, or malignant. Abnormalities characterized by increased lung opacity can be divided into two categories based upon their attenuation. Lung opacities may be classified by their patterns, explains. Groundglass opacity with reticulation radiology key.
Groundglass opacity lung nodules in the era of lung. It can be, and often is, a precusor to lung cancer. A 40yearold woman with progressive shortness of breath. It usually has preserved vascular and bronchial markings as well, and may well be the result of an acute alveolar disease. Differential diagnosis is narrowed based on integration of predominant hrct pattern and clinical history. The highresolution ct term headcheese pattern refers to the coexistence of groundglass opacities, normal lung, and air trapping. We have a solitary pulmonary nodule clinic to evaluate patients with ground glass opacities. Differential diagnosis and management of focal groundglass. To define groundglass opacity ggo and to show how it can be detected on hrct scans for diffuse lung diseases.
A man in his 50s with hemoptysis, dyspnea, and bilateral. Although there is a differential diagnosis for this highresolution ct pattern, it is common in cluster 1 hypersensitivity pneumonitis 31. Various typical and atypical imaging findings for pulmonary sarcoidosis have been described in the literature. When the cysts have thick walls like in langerhans cell histiocytosis or honeycombing, it frequently presents as a reticular pattern on a cxr. Approach to groundglass opacification of the lung kenneth nowers, j. In chest radiology, reticular and linear opacification refers to a broad subgroup of pulmonary opacification caused by a decrease in the gas to soft tissue ratio due to a pathological process centered in or around the pulmonary interstitium.
Evaluation of lesions corresponding to ground glass opacities that were resected after computed tomography followup examination. Although initially described in patients with endobronchial tuberculosis, it is now recognized in a large number o. The association between baseline clinicalradiological characteristics and growth of pulmonary nodules with ground glass opacity. Groundglass opacities often represent parenchymal abnormalities below the spatial resolution of highresolution ct of the lung. Miled dependent atelectasis and scarring are noted. We always hope for the former, but in my case, it is likely the latter. Diffuse large bcell lymphoma presenting as diffuse. Chung, the studys senior author, is an assistant professor of diagnostic, molecular and interventional radiology, and medicine cardiology. Ground glass opacities ggos may indicate a variety of acute, chronic, or other diseases.
Groundglass opacity lung nodules in the era of lung cancer. Approach to groundglass opacification of the lung sciencedirect. This pictorial essay illustrates the pathologic basis of groundglass opacity and provides a guide to the differential diagnosis of the disorders that can produce. Videoassisted thoracic surgery for pure ground glass opacities 2 cm or less in diameter. The opacities may represent areas of lung infection or tumors.
Pulmonary nodules with groundglass opacity ggo are frequently observed and will be increasingly detected. Groundglass opacification radiology reference article. Oct 12, 2015 a nonsmoking woman sought medical attention for nonproductive cough, dyspnea, lowgrade fever, chills, and fatigue of 2 months duration. An oslerphile emergency physician and intensivist suffering from a bad case of knowledge dipsosis. 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. The ct image shows diffuse bilateral confluent and patchy ground glass and consolidative pulmonary opacities, with a striking peripheral distribution in the right lower lobe. Reticular and linear pulmonary opacification radiology. Your doctor may decide to follow it up with periodic radiology to assess stability or opt for tissue diagnosis.
Measurement of focal ground glass opacity diameters on ct images. The differential diagnosis of the many causes of ggo includes pulmonary edema, infections. Minimally invasive adenocarcinoma is the new term for bac, or broncioaveolar carcinoma. These opacities do not make contact with the pleura or fissures fig. Feb, 2020 chest radiograph and chest ct fig 1b,c at presentation showed patchy right lower lobe ground glass opacities. In the other 2040% of the cases the lung disease is not treatable and the groundglass pattern is. Ground glass opacity respiratory disorders medhelp. Focal pulmonary groundglass opacities ggos can be associated with bronchioloalveolar carcinoma. Ground glass opacities are usually not a feature of infections in patients with multiple myeloma crescent, or a cavity, most patients present with subcentimeter centrilobular micronodules, groundglass opacities, treeinbud infiltrates, and focal bronchiectasis. The ground glass pattern is frequently not detected on a chest xray.
Differential diagnosis of groundglass opacity nodules. Groundglass opacity implies a long list of differential diagnoses, almost anything occupying either alveoli or interstitium, or both. Daniel rasband, grant berges, and marc gosselin there are a number of diseases that present with ground glass opacification of the lung as a primary manifestation on chest radiography and thinsection computed tomography ct. Jan, 20 i had a ct scan as a a follow up from having pneumoia in december secondary infection from h1n1.
It is entirely possible to have these lesions for many years. 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. Opacities definition of opacities by medical dictionary. 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. In the other 2040% of the cases the lung disease is not treatable and the ground glass pattern is the result of fibrosis. Mnemonics for peripheral lung opacities seen on chest xray or ct are useful to remember differentials. Atelectasis, consolidation, ground glass opacity, and mosaic attenuation gautham p.
Jun 03, 2011 ground glass opacities often represent parenchymal abnormalities below the spatial resolution of highresolution ct of the lung. 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. Ecr 2019 c2294 groundglass opacities on chest ct scans. Differential diagnosis and management of focal ground. Ground glass opacities often represent parenchymal abnormalities below the spatial resolution of highresolution ct of the lung. Chest radiograph and chest ct fig 1b,c at presentation showed patchy right lower lobe groundglass opacities. 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. In the subacute stage, there are patchy ground glass opacities with illdefined centrilobular nodules, which can progress to heterogeneous ground glass attenuation. Posts about ground glass opacities written by linnea11. 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. 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. Septal thickening and groundglass opacity with a gravitational distribution in a patient. Opacities in the lungs are seen on a chest radiograph when there is a decrease in the ratio of gas to soft tissue in the lungs, according to. Patients with early diffuse pulmonary infiltrative diseases are more likely to present with an area of ground glass opacity in the lung.
This includes thickening of any of the interstitial compartments by blood, water, tumor, cells, fibrous disease or any combination thereof. In acute hp, chest imaging typically reveals diffuse ground glass opacities, although a fine micronodular pattern may also be observed fig. Ground glass opacity implies a long list of differential diagnoses, almost anything occupying either alveoli or interstitium, or both. Predominant diffuse ground glass opacity in both lung.
Approach to ground glass opacification of the lung kenneth nowers, j. The ground glass opacity in the inferior lingula has also increased. It can reflect minimal thickening of the septal or alveolar interstitium. Ggos may represent pneumocystis pneumonia pcp, acute interstitial pneumonia, viral pneumonia, hypersensitivity penumonitis, acute eosinophilic pneumonia, or early interstitial lung disease. Clinical information, particularly the duration of symptoms, can limit the diagnosis when either of these findings is present.
The groundglass pattern is frequently not detected on a chest xray. This kind of pulmonary opacity, which may be patchy or diffuse, was well. D poorly differentiated adenocarcinoma, type e tubular adenocarcinoma. Large opacities, necrosis, cavitation, galaxy sign and ground glass opacity in hrct images are rare manifestations of this disease. Computed tomographic ct imaging of the chest showed slowly progressive, patchy, bilateral ground glass, lowattenuation, consolidative opacities with air bronchograms. The differential diagnosis for this patient with patchy bilateral groundglass opacities on chest ct scan includes several infectious and noninfectious causes. Ground glass is an appearance on a ct of a cluster of lung cells that have changed. A 43yearold woman with breast cancer who was on neoadjuvant chemotherapy presented with cough, sputum and mild fever. However, lymphoma is typically not a serious consideration unless nodules or masslike lesions are also present. Peripheral lung opacities mnemonic radiology reference. Followup chest ct images fig 1d, e obtained 2 days later showed improvement of the groundglass opacities, with development of subpleural curvilinear lines. What does a ground glass lung result from a ct scan mean.
Groundglass centrilobular nodules on multidetector ct. In a series of 98 patients, bilateral opacities were noted in 100 percent, either on the chest radiograph or chest ct. To define ground glass opacity ggo and to show how it can be detected on hrct scans for diffuse lung diseases. Although the differential diagnosis of ground glass opacities at highresolution ct is large, these etiologies may be broadly divided into acute or chronic causes. The ct chest findings of patchy groundglass opacity and superimposed septal. At the hopkins kimmel cancer center, we evaluate carefully whether a ground glass opacity is cancerous or not, hales notes. If youre a patient who was recently told you have something like this, you can certainly call 410955lung, so that we. 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. When these rare manifestations are detected on hrct images, sarcoidosis can easily be mistaken for. The subacute form manifests with centrolobular nodules and ggo, patchy or diffuse ggo.
The lungs are for the most part filled with air, but there is some cellular tissue that makes up the scaffolding in which the air is held. The radiologic differential diagnosis of diffuse bilateral groundglass opacities is broad and includes infection, diffuse alveolar hemorrhage, and interstitial lung disease. These findings may represent mild increase in minimally invasive adenocarcinoma in these regions. The cystic pattern is also difficult to appreciate on a cest xray. The differential diagnosis of multifocal consolidation is wide and can be challenging. Each of these findings tends to be nonspecific and has a long differential diagnosis. Followup chest ct images fig 1d, e obtained 2 days later showed improvement of the ground glass opacities, with development of subpleural curvilinear lines. Reddy, md, mph university of washington learning objectives identify lobar or rounded atelectasis describe diff dx of consolidation discuss causes of ggo differential mosaic from ggo recognize head cheese appearance. Jul 30, 20 kakinuma r, ashizawa k, kuriyama k, et al. Diffuse ground glass opacities are the dominant features in nonspecific interstitial pneumonia and are associated with a homogeneous pattern of cellular pneumonitis at pathologic examination 42,44.
The presence of centrilobular groundglass nodules without associated treeinbud opacities raises suspicion for a background disease, that primarily affects the centrilobular bronchioles with peribronchiolar inflammation or an angiocentric disease with peribronchiolar deposition of hemorrhagic material. Many types of lung lesions can show up as ground glass opacities on a ct scan. Groundglass opacities southwest journal of pulmonary. The patient did not have fevers, chills, chest pain, abdominal pain, or changes in urination. 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.
A man in his 50s presented to the ed with a 3day history of smallvolume hemoptysis and newonset dyspnea. The differential diagnosis for this patient with patchy bilateral groundglass opacities on chest ct scan includes several infectious and. Pulmonary nodules with groundglass opacity ggo are frequently observed and. The association between baseline clinicalradiological characteristics and growth of pulmonary nodules with groundglass opacity. This image shows patchy groundglass opacities throughout both. Ground glass opacity is just a description of an imaging characteristic noted on ct. Sep 03, 2016 abnormalities characterized by increased lung opacity can be divided into two categories based upon their attenuation. Treeinbud sign or pattern describes the ct appearance of multiple areas of centrilobular nodules with a linear branching pattern. It is a nonspecific sign with a wide etiology including infection, chronic interstitial disease and acute alveolar disease. My husbads xray indicated patchy opacities in right. 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.
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