Milchglasverschattungen
The
crazy-paving pattern: a radiological-pathological correlation. Lymphangitic carcinomatosis. a Chest radiograph showed a pleural effusion in the right haemothorax. An increased linear pattern was seen in the left and right upper lung. b CT showed a diffuse crazy-paving pattern with areas of ground-glass attenuation and thickening of the interlobular septa (1). There were also some small nodular lesions visible mostly in the left upper lobe suggestive of pulmonary metastases (2). c Radiological-histopathological correlation. Histological examination of the autopsy specimen demonstrated thickening of the interlobular septa (*) due to fibrosis and the presence of tumour cells. There was also perivascular (arrow) thickening due to an expansion of lymphatic spaces by tumour cells. The histological reaction was that of diffuse alveolar damage and consisted of hyaline membranes in the alveolar ducts and respiratory bronchioles while the alveolar spaces fill with an exudate of proteinaceous material. This corresponded to the ground-glass opacities on CT. The reticular pattern was due to congestion of capillaries and oedema of the interstitium
The
crazy-paving pattern: a radiological-pathological correlation. Acute respiratory distress syndrome. CT revealed bilateral areas with ground-glass attenuation superimposed with a reticular pattern. These lines corresponded to thickening of the interlobular septa, but also thickening of the intralobular interstitium
Long term
bronchoneumoniae that turned out to be a pulmonary alveolar proteinosis. Chest CT (axial (a,b,c and d) and coronal sections (d)) shows widespread geographic ground glass opacities accompanied by smooth thickening of the interlobular septal lines, the "crazy paving" pattern.
The
crazy-paving pattern: a radiological-pathological correlation. Hypersensitivity pneumonitis. a Chest radiograph showed patchy distribution of areas with increased lung density. There was also an increase in the linear pattern in both lungs. b On CT, a crazy-paving pattern was seen with a geographic distribution of ground-glass opacities with the superimposition of thickened inter- (1) and intralobular (2) septa. The findings were seen predominantly in the upper lung areas. c Radiological-histopathological correlation. Histology demonstrated interstitial pneumonia with lymphocytes, plasma cells and foamy macrophages in the interstitium. Epithelioid granulomas without caseation were also seen. There was no fibrosis. The alterations in the walls of the alveoli and the inflammation in the interstitium were visible as thickening of the inter- and intralobular lines
Ground-glass
opacification • Cryptogenic organizing pneumonia - Ganzer Fall bei Radiopaedia
Ground-glass
opacification • Angioinvasive aspergillosis - Ganzer Fall bei Radiopaedia
Ground-glass
opacification • Ground glass stoppers - Ganzer Fall bei Radiopaedia
The
crazy-paving pattern: a radiological-pathological correlation. Bronchioloalveolar carcinoma. CT showed patchy distribution of areas with ground-glass opacification and areas with consolidation. Superimposed on these areas there is a reticular pattern corresponding to the thickening of the interstitium
A typical
carcinoid tumor of the lung presenting with pure persistent ground-glass opacity on high-resolution computed tomography: a case report. a High-resolution computed tomography of the pure ground-glass nodule. Focal p-GGO was identified in the right middle lobe of the lung. b Hematoxylin staining of the resected specimen. Small round to spindle-shaped cells arranged in a spindle cell pattern with finely granular chromatin, inconspicuous nucleoli, and a scant to moderate amount of eosinophilic cytoplasm were seen in the form of many scattered tumor foci (arrowheads). c Immunohistological staining showed the tumor cells are positive for synaptophysin A
Pigeon
fanciers lung: a case report. Chest radiograph showing bilateral interstitial reticular shadowing with loss of lung volume.
Pigeon
fanciers lung: a case report. Computed tomography scan of the thorax showing extensive honeycombing in both lungs with widespread ground glass opacification and patchy asymmetrical areas of normal lung tissue.
The
crazy-paving pattern: a radiological-pathological correlation. Alveolar proteinosis. a Chest radiograph showed a reticular pattern that was most pronounced in the central parts of the lungs. There was also a decrease in the lung translucency centrally in both lungs. Heart and central vessels were normal. There was no pleural effusion. b On CT, a patchy distribution of a crazy-paving pattern was visible. The lines corresponded to a deposition of material within the airspaces at the borders of the acini (1) in the secondary pulmonary lobules, but also along the interlobular (2) and intralobular septa (3): the periacinar pattern. c Radiological-histopathological correlation. Histopathological evaluation of a specimen out of the right lung showed amorphous eosinophilic material in the alveoli (*) positive on periodic acid Schiff (PAS) staining. This material corresponded to deficient surfactant. Filling of the alveoli (*) was responsible for the ground-glass appearance on CT. When the airspaces adjacent to the inter- and intralobular septa (black arrow) and to the alveolar walls filled, the periacinar pattern became visible
The
crazy-paving pattern: a radiological-pathological correlation. Non-specific interstitial pneumonia. a Chest radiograph showed reticulation in the lung parenchyma, diffusely spread in both lungs, centrally and peripherally. b Chest CT showed a crazy-paving pattern especially at the periphery of both lungs. There was an increase in lung attenuation (ground-glass opacification) with a superimposition of a reticular pattern with thickening of the inter- (1) and intralobular (2) septa. c Radiological-histopathological correlation. Histological evaluation showed a homogeneous fibrotic thickening of the interstitium with inflammation. Macrophages were visible within the alveolar septa. Homogeneous interstitial inflammation was seen, corresponding to the diffuse ground-glass opacities, whereas fibrosis in the interstitium and alveolar septa (black arrow) was related to the superimposed linear pattern
The
crazy-paving pattern: a radiological-pathological correlation. Usual interstitial pneumonia. a Chest radiograph showed patchy distribution of areas with consolidation and a fine reticular pattern, most pronounced in the periphery of both lungs. b A crazy-paving pattern was visible with scattered distribution. Superimposed on the ground-glass opacities a linear pattern with multiple small irregular lines was visible (intralobular fibrosis) (1). Traction bronchiectasis was seen in the periphery of both lungs (white arrow). c Radiological-histopathological correlation. On histology, thickening of the interstitium (arrow) with variable severity was seen, leaving some alveolar septa almost completely normal, whereas others were thickened. Fibrinous exudates, honeycombing (*) and mild inflammatory alveolitis were also present
The
crazy-paving pattern: a radiological-pathological correlation. Exogenous lipid pneumonia. a Chest radiograph showed a decrease in lung translucency in the caudal region of the right lung with an air bronchogram. b Chest CT showed a crazy-paving pattern with areas of increased lung attenuation and with thickening of interlobular septa (1), even thickening of the intralobular interstitium (2). c Radiological-histopathological correlation. Histological examination showed alveoli filled with lipid particles (*), some ingested in macrophages (+) with the formation of lipid granulomas
Clinical and
radiological features of lung disorders related to connective-tissue diseases: a pictorial essay. Axial (A, B) and coronal (C) HRCT images of an SSc patient demonstrate NSIP pattern with ground-glass opacities (black arrows), well depicted in the subpleural and basal regions of the lung; fine reticulations may be also observed. Coronal MPR image is useful to better delineate the presence of small bronchiectasis, which may be seen in the peripheral basal regions (white empty arrows)
The
crazy-paving pattern: a radiological-pathological correlation. Radiation pneumonitis. a Chest radiograph showed an area of consolidation in the right lung with an air bronchogram. There was also loss of volume of the right lung. b CT showed the therapy response of the tumour. There was patchy distribution of a crazy-paving pattern with increased lung attenuation (ground-glass opacity) and thickening of the interlobular septa in the right lung (1). c Radiological-histopathological correlation. Histological examination after autopsy showed airspace filling with an exudate in combination with thickening of the interlobular septa (arrow), thickening of the interstitium surrounding the airspaces and also the presence of irregular fibrosis (dotted arrow). Alveolar spaces filled with an exudate of proteinaceous material were responsible for the ground-glass opacities on CT. The reticular pattern was due to congestion of capillaries and oedema of the interstitium
The
crazy-paving pattern: a radiological-pathological correlation. Pneumocystis jirovecii infection. CT showed a patchy distribution of areas with ground-glass opacification in both lungs, more pronounced in central parts, with a superimposition of a linear pattern
The
crazy-paving pattern: a radiological-pathological correlation. Pulmonary oedema. CT showed patchy distribution of areas with ground-glass opacification and a linear pattern. Most of the lines were thickened interlobular septa. Within the secondary pulmonary lobule, enlarged vascular structures with a spider configuration were seen. There were also some other intralobular lines
The
crazy-paving pattern: a radiological-pathological correlation. Sarcoidosis. CT showed a diffuse increase in lung attenuation (ground-glass attenuation) with the superimposition of an irregular reticular pattern: thickening of the interstitium and thickening of the peribronchovascular interstitium
The
crazy-paving pattern: a radiological-pathological correlation. Graft-versus-host disease. CT revealed multiple areas of ground-glass attenuation and consolidations. There was also a superimposition of multiple lines: thickened inter- and intralobular septa and intralobular fibrosis
The
crazy-paving pattern: a radiological-pathological correlation. Organising pneumonia. CT showed patchy distribution of areas of ground-glass opacification with the superimposition of thickened interlobular septa
Ground-glass
opacification • H1N1 pneumonia - Ganzer Fall bei Radiopaedia
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. It is a non-specific sign with a wide etiology including infection, chronic interstitial disease and acute alveolar disease.
Ground glass opacification is also used in chest radiography to refer to a region of hazy lung radiopacity, often fairly diffuse, in which the edges of the pulmonary vessels may be difficult to appreciate .
The use of the term ground glass derives from the industrial technique in glassmaking whereby the surface of normal glass is roughened by grinding it.
Pathology
Etiology
Ground-glass opacities have a broad etiology:
- normal expiration
- on expiratory acquisitions, which can be detected if the posterior membranous wall of the trachea is flattened or bowed inwards
- partial filling of air spaces
- partial collapse of alveoli
- interstitial thickening
- inflammation
- edema
- fibrosis
- lepidic proliferation of neoplasm
Morphological forms
- focal ground-glass opacification (i.e. ground-glass nodule)
- diffuse ground-glass opacification
- isolated diffuse ground-glass opacification
Differential diagnosis
Broadly speaking, the differential for ground-glass opacification can be split into :
- infectious processes (opportunistic vs non-opportunistic)
- chronic interstitial diseases
- acute alveolar diseases
- other causes
Infections
Opportunistic
- pneumocystis pneumonia (PCP/PJP)
- cytomegalovirus (CMV) pneumonia
- herpes simplex virus (HSV) pneumonia
- respiratory syncytial virus (RSV) bronchiolitis: type of infectious bronchiolitis
- other infectious causes
Non-opportunistic
Chronic interstitial diseases
- eosinophilic pneumonias: ground-glass opacification can be seen in many of the eosinophilic pneumonias but is most commonly seen in :
- simple pulmonary eosinophilia (SPE): nodules with a GGO halo
- idiopathic hypereosinophilic syndrome (IHS): nodules with a GGO halo
- acute eosinophilic pneumonia (AEP): bilateral patchy areas of GGO with interlobular septal thickening
- eosinophilic drug reactions: peripheral airspace consolidation and GGO
- idiopathic interstitial pneumonias
- non-specific interstitial pneumonia: GGO with linear or reticular markings, micronodules, consolidation, and microcystic honeycombing
- usual interstitial pneumonia (UIP): focal GGO with macrocystic honeycombing, reticular opacities, traction bronchiectasis, and architectural distortion
- cryptogenic organizing pneumonia (COP): formerly bronchiolitis obliterans with organizing pneumonia (BOOP); GGO with airspace consolidation and mild bronchial dilatation
- exudative phase of acute interstitial pneumonia (AIP): diffuse lung consolidation with GGO
- respiratory bronchiolitis-associated interstitial lung disease (RB-ILD): patchy GGO centrilobular nodules and bronchial wall thickening
- desquamative interstitial pneumonia (DIP): GGO with linear or reticular opacities
- lymphoid interstitial pneumonia (LIP): GGO often in association with perivascular cystic lesions, septal thickening, and centrilobular nodules
- sarcoidosis (pulmonary manifestations of sarcoidosis)
Acute alveolar disease
- alveolar edema or pulmonary edema
- hypersensitivity pneumonitis: especially acute and subacute forms
Other causes
- neoplastic processes with a lepidic proliferation pattern
- atypical adenomatous hyperplasia
- localized adenocarcinoma
- adenocarcinoma in situ or minimally invasive (formerly bronchoalveolar cell carcinoma)
- drug toxicity
Rare causes
- focal interstitial fibrosis: a non-neoplastic entity with a nodular ground-glass opacity that does not change over a long period of time; can be mistaken for a neoplastic process
- aspergillosis: a nodule with surrounding ground-glass opacity (CT halo sign) is rare except in severely immunocompromised patients
- thoracic endometriosis
- traumatic lung injury (pulmonary contusion)
- poisoning e.g. acute/subacute phase of paraquat poisoning
- pulmonary cryptococcus infection: solitary or multiple pulmonary nodules with or without peripheral GGO
- granulomatosis with polyangiitis
- Henoch-Schönlein purpura
- metal fume fever
See also
Siehe auch:
- Sarkoidose
- Kryptogene organisierende Pneumonie (COP)
- Honigwabenmuster
- pulmonale und mediastinale Sarcoidose
- Granulomatose mit Polyangiitis
- Milchglasherd
- acute respiratory distress syndrome (ARDS)
- vaping-induced acute lung injury (EVALI)
- aspergillosis
- infectious bronchiolitis
- idiopathic hypereosinophilic syndrome
- Nicht spezifische interstitielle Pneumonie (NSIP)
- pulmonale Eosinophilie
- acute eosinophilic pneumonia
- diffuse ground glass nodules
- In Situ Adenokarzinom der Lunge
- Lungenkontusion
- respiratory bronchiolitis–associated interstitial lung disease
- CT halo sign
- gewöhnliche interstitielle Pneumonie (UIP)
- Akute interstitielle Pneumonie
- lymphozytisch interstitielle Pneumonie
- Pneumocystis jiroveci Pneumonie
- Idiopathische interstitielle Pneumonie
- Desquamative interstitielle Pneumonie (DIP)
- IgA-Vaskulitis
und weiter:
- umgekehrtes Halozeichen Lunge
- mosaikartige Verdichtungen der Lunge
- Hypersensitivitätspneumonitis
- reverse halo sign
- Alveolarproteinose
- angioinvasive pulmonale Aspergillose
- Sjögren-Syndrom
- pulmonary opacification
- alveoläre Mikrolithiasis
- lung torsion
- bronchus associated lymphoid tissue lymphoma
- HRCT terminology
- Strahlenpneumonitis
- sub acute extrinsic allergic alveolitis
- head cheese sign
- byssinosis
- diffuses Milchglasphänomen
- pulmonale Manifestationen der Leukämie
- eosinophile Granulomatose mit Polyangiitis
- Kaposisarkom
- follikuläre Bronchiolitis
- diffuse idiopathische pulmonale neuroendocrine Zellhyperplasie
Assoziationen und Differentialdiagnosen zu Milchglasverschattungen:
pulmonale
Eosinophilie ⤙•⤚ Milchglasverschattungen
gewöhnliche
interstitielle Pneumonie (UIP) ⤙•⤚ Milchglasverschattungen
lymphozytisch
interstitielle Pneumonie ⤙•⤚ Milchglasverschattungen
Akute
interstitielle Pneumonie ⤙•⤚ Milchglasverschattungen
respiratory
bronchiolitis–associated interstitial lung disease ⤙•⤚ Milchglasverschattungen
Nicht
spezifische interstitielle Pneumonie (NSIP) ⤙•⤚ Milchglasverschattungen
infectious
bronchiolitis ⤙•⤚ Milchglasverschattungen
desquamative
interstitial pneumonia ⤙•⤚ Milchglasverschattungen
