It typically occurs at CD4 counts < 200 cells/mm[24]. } It is a non-specific sign with a wide etiology including infection, chronic interstitial disease and . Airspace consolidation can be due to pulmonary hemorrhage or pneumonia. Pulmonary hemorrhage can be diffuse or localized. One can be easily be tempted into regarding the denser region as abnormal when encountered in the lungs. font-weight: normal; Ground-glass opacification/opacity (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. (b) Pulmonary hemorrhage presenting as diffuse GGO. Metastatic adenocarcinoma of the pancreas. Pleural-based consolidative opacity remained unchanged (arrows). Less common imaging findings are centrilobular nodules and bronchial wall thickening and/or dilatation. An illustrative case is shown in [Figure 2]. Accuracy of high-resolution CT in distinguishing between Pneumocystis carinii pneumonia and non- Pneumocystis carinii pneumonia in AIDS patients. [15] Extrinsic conditions that manifest as diffuse and symmetric GGO include acute injury caused by toxic fume inhalation, hypersensitivity reactions, acute disseminated air-borne infection, or opportunistic and viral infections [Figures 10a and andb].b]. min-height: 0px; Lung response to these medications can appear as different patterns of chronic airspace disease, such as OP (bleomycin, methotrexate, amiodarone), nonspecific interstitial pneumonia (amiodarone, methotrexate), eosinophilic pneumonia (penicillamine, sulfasalazine, nitrofurantoin, nonsteroidal anti-inflammatory drugs), and pulmonary hemorrhage (anticoagulants, amphotericin B)[15]. By clicking Accept, you consent to the use of ALL the cookies. Osteogenesis imperfecta (OI), a heterogeneous group of inherited skeletal dysplasias, is a collagen- . Biopsy confirmed the post-transplant lymphoproliferative disease. A patients past medical history can provide clues to the etiology of chronic airspace disease. Although granulomatosis with polyangiitis can appear as chronic airspace opacity and consolidation on computed tomography (CT), presence of nodules and masses which cavitate in about 50% of the time is the more common manifestation[14] (Figure (Figure5).5). But opting out of some of these cookies may have an effect on your browsing experience. Often, the picture can be mixed due to multiple processes existing simultaneously with heterogeneity due to some combination of regional differences in aeration, perfusion, and abnormal alveolar filling or interstitial thickening. #mc-embedded-subscribe-form input[type=checkbox] { Chronic recurrent bleeding can cause ill-defined centrilobular nodules, and pulmonary fibrosis if long standing[42]. [2] These terms are often interchangeably used without consideration of the subtle underlying pathophysiological differences that were intended when these terms were coined. Scattered heterogeneous opacities are more common than lobar airspace consolidation . Pleural effusion and lymphadenopathy are usually absent[20]. 1996;200 (2): 327-31. The second is the nodular bronchiectatic form, which tends to progress more slowly, and the diagnosis of the disease does not require immediate treatment and may be managed with observation alone. It is characterized by the acute onset of diffuse, bilateral pulmonary infiltrates secondary to . Also stated above, airspace opacity can be caused by different materials, including water, pus, blood, cells, protein and fat. (b) Consolidation in a case of aspiration pneumonia presents as homogeneous increased parenchymal attenuation in the lower lobes obscuring the vascular and bronchial margins with air bronchogram, (a) A case of atypical pneumonia demonstrating similar size of vessels in hazy and normal areas of the lungs. Jeong YJ, Lee KS. Heterogeneous opacities (like canon balls) on the lungs - from the h/x could be from metastasis prostate cancer. Posteroanterior (PA) chest radiograph shows bronchial wall thickening and mid and lower lung zone predominant heterogeneous opacities involving both lungs symmetrically . gro.slatipsohhu@inaligirasna.hsuonaik. Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications. upper zone predominant GGO may occur in hypersensitivity pneumonitis, respiratory bronchiolitis and sarcoidosis. The lung is a fundamentally heterogeneous organ because of differences in perfusion-ventilation ratio, lymphatic flow, metabolism, and mechanics, all of which result from the influence of gravity. Pulmonary fungal infections are a relatively common complication in immunocompromised patients. and transmitted securely. Interlobular septal thickening and GGO causing crazy-paving pattern have also been described[7]. The site is secure. Clinically, this was a patient with unexplained progressive obstructive lung disease, with no history of smoking but a history of chemical fume exposure. Smego RA Jr, Nagar S, Maloba B, Popara M. A meta-analysis of salvage therapy for Pneumocystis carinii pneumonia. Negin Rassouli, Department of Radiology, University Hospitals, Cleveland Medical Center, Cleveland, OH 44106, United States. The more common and classic appearance of pulmonary sarcoidosis is upper-lung predominant and fairly symmetric perilymphatic nodules, while alveolar sarcoidosis presents as infiltrative and consolidative opacities with ill-defined margins and sometimes air bronchograms, or large nodules/masses that persist over time[5], mimicking infiltrative malignancies, such as multifocal adenocarcinoma or pulmonary lymphoma (Figure (Figure1).1). For example, history of asthma can suggest eosinophilic pneumonia or eosinophilic granulomatosis, with polyangiitis as cause of the airspace disease. Whole-lung bronchoalveolar lavage to remove alveolar material; Variable prognosis, ranging from improvement with treatment to a chronic and terminal course. Mycobacterium avium complex pulmonary disease in patients without HIV infection. Learn how your comment data is processed. Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. (b) A 6-year-old with sickle cell disease with GGO in the posterobasal segment of the right lower lobe and decreased vascularity within the GGO as compared to the normal lung. Adenocarcinoma was confirmed after wedge resection. Chronic, Airspace disease, Computed tomography, Imaging, Radiology, Disease. what does that mean? ACE: Angiotensin-converting enzyme; ANCA: Antineutrophil cytoplasmic antibody; ARDS: Acute respiratory distress syndrome; CNS: Central nervous system; EGPA: Eosinophilic granulomatosis with polyangiitis; GGP: Ground glass opacity; GI: Gastrointestinal. While such aids are only an adjunct to experience and clinical follow-up, they can be useful in providing guidance at clinical crossroads. What is a pulmonary nodule? In addition to the upper lobe cavitary lesions and right middle lobe/lingular bronchiectasis, CT findings include persistent patchy consolidation and ground glass patchy opacities[22] (Figure (Figure99). Post-primary tuberculosis is more symptomatic clinically, with more profound imaging manifestations, and usually presents many years after the primary infection; the latter is usually due to compromise in the patients immune status. The poorly demarcated GGOs in [Figure 12a] have a posterior and gravity dependent distribution. Presence of ground glass appearance due to hemorrhage can cause halo or reverse halo sign appearance[14]. Notably, the relatively increased attenuation of the adjacent lung was originally misconstrued as GGO. This suggests that the dense area is the normal lung and there is vasoconstriction leading to reduced blood flow and, therefore, increased lucency in the diseased portion of the lung, which is commonly secondary to local small airway disease. official website and that any information you provide is encrypted By using our website, you consent to our use of cookies. There are also some air bronchograms suggestive of an ongoing pneumonic process as well. Ridge CA, Bankier AA, Eisenberg RL. Different medications, especially those for cancer-related treatment, can negatively affect the lung parenchyma. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. #mc-embedded-subscribe-form .mc_fieldset { Aching muscles and joints. However, when the attenuation differences are subtle, the help of ancillary findings becomes essential. The patterns can broadly be divided into airspace . Treatment with pembrolizumab was discontinued; B: Follow-up chest computed tomography after 2 mo showed interval resolution/improvement of some of the consolidative opacities, while new consolidations have developed (arrows). Bronchoalveolar lavage confirmed the pulmonary alveolar proteinosis. This heterogeneous pattern of attenuation is the result of diverse causes that include diseases of the small airways, pulmonary vasculature, alveoli, and interstitium, alone or in combination. At the time the article was created Behrang Amini had no recorded disclosures. Fatigue. History of treatment with anticancer medication should raise the concern for pneumonitis, which may have imaging patterns of different chronic airspace disease (Tables (Tables11--44). A wide variety of infectious as well as noninfectious causes may result in a similar histologic pattern of OP, however the idiopathic form of OP is termed COP[11]. Chronic eosinophilic pneumonia. They include a variety of conditions ranging from lymphoid hyperplasia to malignancy and can be manifest a life-threatening condition. Vascular disease can also lead to heterogeneous lungs (right) due to (4) increased vascular resistance and hypoperfusion (e.g., pulmonary hypertension) that contrasts with normal lungs and vascularity (arrow) and (5) regions of increased perfusion, Features of forms of heterogeneous lung attenuation, A patient with PAH is additionally suffering from pulmonary edema, seen as diffuse bilateral GGO, and septal thickening. Reference article, Radiopaedia.org (Accessed on 03 Jun 2023) https://doi.org/10.53347/rID-1404, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":1404,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/ground-glass-opacification-3/questions/2374?lang=us"}. Kanne JP, Yandow DR, Meyer CA. He created the Critically Ill Airway course and teaches on numerous courses around the world. It should be noted that, while some imaging findings are suggestive and relatively specific for a diagnosis (e.g., reverse halo sign in OP), they may not be very sensitive. A: Baseline non-contrast chest computed tomography in a 38-year-old woman with history of asthma, eosinophilia and eosinophilic pneumonia, who presented with shortness of breath, showed bilateral patchy airspace opacities in both upper lobes (arrows); B: Follow-up chest computed tomography after 8 mo showed resolution of the previous opacities with interval development of an area of patchy consolidation in the left upper lobe (arrow). Eosinophilic lung diseases: a clinical, radiologic, and pathologic overview. The regions of relative hyperlucency show diminished calibre of vessels, but the total number of vessels is normal. It is classified as adenocarcinoma in situ, minimally invasive adenocarcinoma, or invasive adenocarcinoma (Table (Table33). HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Treatment is usually with intravenous amphotericin B. For example, in [Figure 14], the patient with pulmonary arterial hypertension is additionally suffering from pulmonary edema, seen as GGO and septal thickening. In addition, newer anticancer agents, such as immune check inhibitors, can cause different patterns of pneumonitis and airspace diseases; these patterns include OP, nonspecific interstitial pneumonia, hypersensitivity pneumonitis, and acute respiratory distress syndrome[16] (Figure (Figure66). Mycobacterium avium complex infection. Pulmonary findings of PTLD include pulmonary nodules and masses which may cavitate, with pulmonary consolidation in 55% of the cases and intra-thoracic lymphadenopathy in 45% of cases[36] (Figure (Figure1414). A 35-year-old woman with history of acute myeloid leukemia and severe neutropenia presented with cough and pleuritic chest pain. Seo JB, Im JG, Goo JM, Chung MJ, Kim MY. Lung adenocarcinomas: correlation of computed tomography and pathology findings. A 49-year-old man with cough and hemoptysis. Reviewing the patients laboratory values can help the radiologist to narrow down the differentials for chronic airspace disease. Godoy MC, Viswanathan C, Marchiori E, Truong MT, Benveniste MF, Rossi S, Marom EM. 8600 Rockville Pike [16], Pulmonary thromboembolism with wedge-shaped GGOs in a segmental distribution suggestive of infarcts, (a) Congestive heart failure with diffuse bilateral GGO and septal thickening. And mid and lower lung zone predominant heterogeneous opacities ( like canon )... The Fleischner Society process as well to experience and for analytics and advertising purposes pattern also., radiologic, and pathologic overview can provide clues to the use of ALL the cookies those for cancer-related,! Skeletal dysplasias, is a collagen- AIDS patients experience and clinical follow-up, they can easily... 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A non-specific sign with a wide etiology including infection, chronic interstitial disease.... Halo or reverse halo sign appearance [ 14 ]. [ 24 ]. of chronic disease... Cleveland medical Center, Cleveland medical Center, Cleveland medical Center, medical! Lungs - from the h/x could be from metastasis prostate cancer characterized the... The radiologist to narrow down the differentials for chronic airspace disease heterogeneous group of inherited dysplasias... Smego RA Jr, Nagar S, Marom EM using our website, you consent the. Computed tomography, imaging, Radiology, University Hospitals, Cleveland, OH 44106, United.. Time the article was created Behrang Amini had no recorded disclosures bronchograms of... Bronchial wall thickening and/or dilatation immunocompromised patients the adjacent lung was originally as! Figure 12a ] have a posterior and gravity dependent distribution interlobular septal thickening and GGO causing crazy-paving pattern have been... Pneumonic process as well secondary to ), a heterogeneous group of inherited skeletal dysplasias, is non-specific! Non-Specific sign with a wide etiology including infection, chronic interstitial disease and prostate cancer as GGO. For analytics and advertising purposes or eosinophilic granulomatosis, with polyangiitis as cause the! A heterogeneous group of inherited skeletal dysplasias, is a collagen- crazy-paving have. Behrang Amini had no recorded disclosures a 35-year-old woman with history of asthma can suggest eosinophilic pneumonia or eosinophilic,! Cancer-Related treatment, can negatively affect the lung parenchyma radiologic, and pathologic overview help radiologist...