Ground-glass opacity (GGO) is a radiological term indicating an area of hazy increased lung opacity through which vessels and bronchial structures may still be seen. When a substance other than air fills an area of the lung it increases that area's density. Agarwal adds that in radiologic terms, ‘ground glass’ means that a hazy lung opacity shows up on imaging that is not dense enough to obscure any underlying pulmonary vessels or bronchial walls. Ground-glass opacity (GGO) is the descriptive term used to refer to this hazy area. Ground-glass nodule – this is also known as a non-solid nodule (difficult to interpret and diagnose, due to the area of haziness and the margins that are not clearly defined) Antibiotics may be prescribed for infections in the lungs, and oxygen or bronchodilators are prescribed to help patients with silicosis breathe, according to the American Lung Association. Patients with early diffuse pulmonary infiltrative diseases are more likely to present with an area of ground glass opacity in the lung. A correlation of imaging with a patient's clinical features is useful in narrowing the diagnosis. Eosinophilic lung diseases: a clinical, radiologic, and pathologic overview. [2][6][8][9][10], There are seven general patterns of ground-glass opacities. Abstract: Pulmonary nodules with ground-glass opacity (GGO) are frequently observed and will be increasingly detected. It is often the result of occlusion of small pulmonary arteries or obstruction of small airways leading to air trapping. [3][5] GGO can be used to describe both focal and diffuse areas of increased density. Mueller-mang C, Grosse C, Schmid K et-al. Focal interstitial fibrosis presents a unique challenge when differentiating from malignant nodular GGOs on CT imaging. Many types of lung lesions can show up as ground glass opacities on a CT scan. 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. isolated diffuse ground-glass opacification, respiratory syncytial virus (RSV) bronchiolitis, Middle East respiratory syndrome coronavirus (MERS-CoV) infection, idiopathic hypereosinophilic syndrome (IHS), respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), desquamative interstitial pneumonia (DIP), adult respiratory distress syndrome (ARDS), adenocarcinoma in situ or minimally invasive, hockey stick sign (Creutzfeldt-Jakob disease), stepladder sign (intracapsular breast implant rupture), stepladder sign (small bowel obstruction), eccentric target sign (cerebral toxoplasmosis), trident sign (persistent primitive trigeminal artery), ginkgo leaf sign (subcutaneous emphysema), butterfly shape of the grey matter of the spinal cord, snake-eye appearance (cervical spinal cord), caput medusae sign (developmental venous anomaly), ice cream cone sign (middle ear ossicles), ice cream cone sign (vestibular schwannoma), in total anomalous pulmonary venous return, on expiratory acquisitions, which can be detected if the posterior membranous wall of the trachea is flattened or bowed inwards, eosinophilic drug reactions: peripheral airspace consolidation and GGO, neoplastic processes with a lepidic proliferation pattern. The findings of ground glass opacity are seen in many lung conditions and need to be correlated with your clinical findings. Pulmonary edema is a condition involving the accumulation of fluid in the lungs, often due to heart disease. [17] GGOs with mixed consolidation has most often been found in elderly populations. 7. In CT, the term refers to one or multiple areas of increased attenuation (density) without concealment of the pulmonary vasculature. During initial stages, this is most often found in the lower lobes, although involvement of the upper lobes and right middle lobe has also been reported early in the disease course. In chest radiographs, the term refers to one or multiple areas in which the normally darker-appearing (air-filled) lung appears more opaque, hazy, or cloudy. patients with AIDS) or immunosuppressed individuals, is a classic cause of diffuse GGOs. journal.publications.chestnet.org 309 Radiology. Isaka T, Yokose T, Ito H, et al. Radiographics. Ground-glass opacity is defined as increased pulmonary opacity without obscuration of underlying bronchial and vascular margins (as opposed to consolidation, which obscures visualization of these structures). Miller WT, Shah RM. [6], A mosaic pattern of GGO refers to multiple irregular areas of both increased attenuation and decreased attenuation on CT. Ground glass opacity (GGO). [] However, these changes are nonspecific and are often seen in numerous end-stage interstitial lung diseases (ILDs). It is typically diffuse, involving larger areas of one or multiple lobes. [24] The original published definition read as: "Any extended, finely granular pattern of pulmonary opacity within which normal anatomic details are partly obscured; from a fancied resemblance to etched or abraded glass. Radiographic and CT Features of Viral Pneumonia. This discussion focuses on the management of … [10], Pre-malignant or malignant causes of nodular GGOs include adenocarcinoma, adenocarcinoma in situ, and atypical adenomatous hyperplasia (AAH). A diffuse haziness would typically be caused by inflammation or thickening of tissues and there's a variety of different causes and patterns. Jeong YJ, Kim KI, Seo IJ et-al. [6], Inflammation and fibrosis can also cause diffuse GGOs. This may coexist with granulomatosis with polyangiitis, leading to diffuse areas of increased attenuation with ground-glass appearance. It can be, and often is, a precusor to lung cancer. Isolated diffuse ground-glass opacity in thoracic CT: causes and clinical presentations. Ground-glass opacities have a broad etiology: Broadly speaking, the differential for ground-glass opacification can be split into 5: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Most bacterial infections lead to lobar consolidation, while atypical pneumonias may cause GGOs. A bacterial lung infection is pneumonia. Computed tomography of the chest revealed a primary mass lesion in the upper lobe of the right lung and … Ground-glass opacities have a broad etiology: 1. normal expiration 1.1. particularly on expiratory acquisitions, which can be detected if the posterior membranous wall of the trachea is flattened or bowed inwards 2. partial filling of air spaces 3. partial collapse of alveoli 4. interstitial thickening 5. inflammation 6. edema 7. fibrosis 8. lepidic proliferationof neoplasm 1. focal ground-glass opacification 2. diffuse ground-glass opa… Diffuse alveolar hemorrhage is a rarer cause of diffuse GGO seen in some types of vasculitis, autoimmune conditions, and bleeding disorders. 1. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. In your case it looks like haziness is caused by inflammation, and if you received antibiotics, it means the inflammation was caused by a bacterial infection. 2. The case of a 55-year-old female presenting with adenocarcinoma of the lung is herein reported. 27 (3): 595-615. [17][18] One systematic review found that among patients with COVID-19 and abnormal lung findings on CT, greater than 80% had GGOs, with greater than 50% having mixed GGOs and consolidation. CT showing diffuse ground-glass opacities in periphery of both lungs in patient with COVID-19. 2005;184 (2): 613-22. 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 7. ground-glass opacities are abnormal findings on a ct scan of the lungs. It is typically defined as an area of hazy opacification (x-ray) or increased attenuation (CT) due to air displacement by fluid, airway collapse, fibrosis, or a neoplastic process. This sometimes resembles a road paved with irregular bricks or tiles. Vessels are well seen in the areas of opacity; this finding defines GGO. It is typically persistent over long-term imaging follow-up and shares a similar appearance to malignant nodular GGOs. A pattern of centrilobular ground-glass nodules is fairly spe … There is not any real "glass" in your lung -- it is just a description of haziness seen on your xray, which doctors call "ground glass opacity". Nodular ground-glass opacity at thin-section CT: histologic correlation and evaluation of change at follow-up. Differentiating between pre-malignancy and malignancy on the basis of CT alone can pose a challenge to radiologists; however, there are several features that that are indicative of pre-malignant nodules. 4. Radiation pneumonitis, a side effect of pulmonary radiation therapy, can lead to pulmonary fibrosis and diffuse GGOs. [6] When combined with a patient's clinical signs and symptoms, the GGO pattern seen on imaging is useful in narrowing the differential diagnosis. [11] In addition, AAH often lacks the solid features and spiculated appearance that are often associated with malignant growths. Ground Glass Opacities Due to infection or another chronic interstitial disease, you may develop a hazy area of increased attenuation in your lung. Ground-glass opacity (GGO) nodules are radiologic findings with focal areas of slightly increased computed tomographic attenuation through which the normal lung parenchyma structures are visually preserved. Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. Furthermore, when a patient lays supine for a CT scan, the posterior lungs are in a dependent position, causing partial collapse of the posterior alveoli. Mosaic attenuation is a descriptive term used in describing a patchwork of regions of differing pulmonary attenuation on CT imaging.It is a non-specific finding, although is associated with the following: obstructive small airways disease: low attenuation regions are abnormal and reflect decreased perfusion of the poorly ventilated regions, e.g. Focal ground-glass opacity on computed tomography suggests several disorders including inflammatory disease, fibrosis, or a primary lung neoplastic lesion, metastatic lung tumor. X-ray finding: "ground glass" is a way of describing the appearance of the lungs in certain pathological states. 27 (2): 391-408. It is important to note that while some disease processes present as only one pattern, many can present with a mixture of GGO patterns. [13] It can also be present in lung infarction where the halo consists of hemorrhage,[15] as well as in infectious diseases such as paracoccidioidomycosis, tuberculosis, and aspergillosis, as well as in granulomatosis with polyangiitis, lymphomatoid granulomatosis, and sarcoidosis.[16]. [18] At this point, many individuals begin showing resolution of consolidation and GGOs as symptoms improve. Chest. What every radiologist should know about idiopathic interstitial pneumonias. CT image showing ground-glass nodule (circled). The first thing that needs to be done is for your doctors to figure out what caused this "ground glass" opacity in the lung. Most commonly, initial CT imaging reveals bilateral GGOs at the periphery of the lungs. Park CM, Goo JM, Lee HJ et-al. (2008) Radiology. Upon expiration there is less air in the lungs, leading to a relative increase in density of the tissue, and thus increased attenuation on CT. 27 (3): 617-37. Lim HJ, Ahn S, Lee KS, et al. [12][19] This is sometimes accompanied by the development of a crazy paving pattern and interlobular septal thickening. Ground-glass opacity is among the most common imaging findings in patients with confirmed COVID-19. [20][21] As the COVID-19 infection progresses, GGOs typically become more diffuse and often progress to consolidation. I do not know if this type of cell change shows up anywhere else. Note ground-glass opacification surrounding the area of consolidation (circled). This is a most commonly seen in various types of pulmonary infections, including CMV pneumonia, tuberculosis, nocardia infection, some fungal pneumonias, and septic emboli. It is typically defined as an area of hazy opacification (x-ray) or increased attenuation (CT) due to air displacement by fluid, airway collapse, fibrosis, or a neoplastic process. These lesions may be infective, inflammatory, benign tumors, or malignant. Chest CT in COVID-19 pneumonia demonstrates bilateral, peripheral, and basal predominant ground-glass opacities (GGOs) and/or consolidation in nearly 85% of patients with superimposed irregular lines and interfaces; the imaging findings peak 9–13 days after infection (7,8) (Fig 1). Persistent pure ground-glass opacity lung nodules >/= 10 mm in diameter at CT scan: histopathologic comparisons and prognostic implications. Lung cancer deaths, n = 0 Other causes of death, n = 6 Lung cancer, n = 113 Stable, n = 86 Growth, n = 27 Benign, n = 17 Stable, n = 11 Growth, n = 6 Figure 1 – Diagram of patients with ground-glass opacity lesions who were registered in the follow-up surveillance. GGO'S were defined by tumor shadow disappearance rate. CT image showing halo sign in patient with pulmonary aspergillosis. 1996;200 (2): 327-31. Cardiogenic pulmonary edema and ARDS are common causes of a fluid-filled lung. Ground-Glass Opacities. For individuals with healthy lungs, lung scans are black. [6], The differential diagnosis for ground-glass opacities is broad. [13] It is often suggestive of organizing pneumonia,[14] but is only seen in about 20% of individuals with this condition. (a, b) Lung window images of CT scans (2.5-mm section thickness) obtained at levels of right middle lobar bronchus (a) and right inferior pulmonary vein (b), respectively, show diffuse ground-glass opacity harboring internal reticulation (crazy-paving appearance, arrows) in both lungs. Fleischner Society: glossary of terms for thoracic imaging. Note the alternating, patchy areas of increased and decreased attenuation, particularly in the left lung (screen right). Many viral pneumonias and idiopathic interstitial pneumonias can also lead to a diffuse GGO pattern. This appears more grey, as opposed to the normally dark-appearing (air-filled) lung on CT imaging. Important non-infectious causes include granulomatosis with polyangiitis, metastatic disease with pulmonary hemorrhage, and some types of idiopathic interstitial pneumonias. Usually adenocarcinoma of the lung. 5. what does this mean? [25], Radiologic sign on radiographs and computed tomography scans, acute respiratory distress syndrome (ARDS), "Review of the Chest CT Differential Diagnosis of Ground-Glass Opacities in the COVID Era", "Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review", "Medical image of the week: pulmonary infarction- the "reverse halo sign, "Coronavirus Disease 2019 (COVID-19) CT Findings: A Systematic Review and Meta-analysis", "Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients", "Chest CT features of coronavirus disease 2019 (COVID-19) pneumonia: key points for radiologists", "Respiratory follow-up of patients with COVID-19 pneumonia", "Glossary of terms for thoracic radiology: recommendations of the Nomenclature Committee of the Fleischner Society", Ground-Glass Opacity of the Lung Parenchyma: A Guide to Analysis with High-Resolution CT, https://en.wikipedia.org/w/index.php?title=Ground-glass_opacity&oldid=997666103, Short description is different from Wikidata, Creative Commons Attribution-ShareAlike License, This page was last edited on 1 January 2021, at 17:26. CT image showing centrilobular pattern of GGOs in patient with pulmonary tuberculosis. [6], The crazy paving pattern may occur when there is both interlobular and intralobular widening. General etiologies include infections, interstitial lung diseases, pulmonary edema, pulmonary hemorrhage, and neoplasm. Hansell DM, Bankier AA, MacMahon H et-al. 3. [17][19] This is in contrast to the two similar coronaviruses, SARS and MERS, which more commonly involve only one lung on initial imaging. [19] In many cases the most severe pulmonary CT abnormalities occurred within 2 weeks after symptoms began. The smaller infants with mean gestational ages of 25–27 weeks and mean gestational weights of 832–979 g were more likely to develop chronic lung abnormalities. There are a variety of potential causes, including Pneumocystis pneumonia, late-stage adenocarcinoma, pulmonary edema, some types of idiopathic interstitial pneumonias, diffuse alveolar hemorrhage, sarcoidosis, and pulmonary alveolar proteinosis. AJR Am J Roentgenol. Ground-glass opacity is in contrast to consolidation, in which the pulmonary vascular markings are obscured. On both x-ray and CT, this appears more grey or hazy as opposed to the normally dark-appearing lungs. Bacteriology The ground glass appearance (GGA) refers to a shadowy pattern seen on culture plates that is midway between the greenish hue of alpha haemolysis, and the ochre-brown of beta-haemolysis, which is incorrectly termed gamma-hemolysis. This leads to an increase in density of the tissue, resulting increased attenuation and a possible ground-glass appearance on CT.[3], In the setting of pneumonia, the presence of GGO (as opposed to consolidation) is a useful diagnostic clue. [] On both x-ray and CT, this appears more grey or hazy as opposed to the normally dark-appearing lungs. It was published as part of a glossary of recommended nomenclature from the Fleischner Society, a group of thoracic imaging radiologists. Unable to process the form. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Ground-glass opacity (GGO) is a finding seen on chest x-ray (radiograph) or computed tomography (CT) imaging of the lungs. Silica is the main component in glass, according to British Glass. These patients may develop lung "white-out" with progression to acute respiratory distress syndrome (ARDS) requiring treatment escalation. Atypical adenomatous hyperplasia and adenocarcinoma in situ are typically manifested as pure GGOs, whereas more advanced adenocarcinomas may include a larger … CT image of reversed halo sign in patient with organizing pneumonia. [1] When a substance other than air fills an area of the lung it increases that area's density. In pathology, honeycomb lung refers to the characteristic appearance of variably sized cysts in a background of densely scarred lung tissue. Comparison between CT tumor size and pathological tumor size in frozen section examinations of lung adenocarcinoma. Ground glass opacities are also seen patients with more severe COVID-19. Several studies have described a pattern among initial, intermediate, and hospital discharge imaging findings in the disease course of COVID-19. In certain clinical circumstances, it can suggest a specific diagnosis, indicate a potentially treatable disease, and guide a clinician to an appropriate area for biopsy. It can be seen even … (2018) Radiographics : a review publication of the Radiological Society of North America, Inc. 38 (3): 719-739. GGO are usually described as either pure ground glass or part solid (subsolid) nodules. Silicosis is a fatal condition; the only treatments available are to ease symptoms. Broadly, a diffuse pattern of GGO can be caused by displacement of air with fluid, inflammatory debris, or fibrosis. [23], The first usage of "ground-glass opacity" by a major radiological society occurred in a 1984 publication of the American Journal of Roentgenology. [19] [6] Sarcoidosis is an additional cause of a mosaic GGOs due to the formation of granulomas in interstitial areas. "[24] It was again included in an updated glossary by the Fleischner Society in 2008 with a more detailed definition. [18][22], Preliminary reports have shown many patients have residual GGOs at time of discharge from the hospital. Radiographics. But coronavirus scans tend to have white patches that radiologists refer to as "ground glass opacity." [12], A halo sign refers to a GGO that fills the area around a consolidation or nodule. CT image showing mosaic attenuation pattern in patient with hypersensitivity pneumonitis. It is entirely possible to have these lesions for many years. According to published criteria, the consolidation should form more than three-fourths of a circle and be at least 2 mm thick. Koo HJ, Lim S, Choe J et-al. It is a non-specific sign with a wide etiology including infection, chronic interstitial disease and acute alveolar disease. Pneumocystis pneumonia, an infection typically seen in immunocompromised (e.g. Ground glass opacities [are] a pattern that can be seen when the lungs are sick. [5] Subtypes of GGOs include diffuse, nodular, centrilobular, mosaic, crazy paving, halo sign, and reversed halo sign. [3] A defining feature of these GGOs is the lack of involvement of the interlobular septum. CT image showing crazy paving pattern of ground-glass opacities in both lungs. [6], The diffuse pattern typically refers to GGOs in multiple lobes of one or both lungs. It is less opaque than consolidation, in which such structures are obscured 1. 246 (3): 697-722. corkscrew sign (diffuse esophageal spasm), bunch of grapes sign (botryoid rhabdomyosarcoma), bunch of grapes sign (intracranial tuberculoma), bunch of grapes sign (multicystic dysplastic kidney), bunch of grapes sign (intraosseous hemangiomas). Pneumonia is the infection of the air sacs of the lungs which often appears patchy or opaque on X-rays. However, some patients have worsening symptoms and imaging findings, with further increase in septal thickening, GGOs, and consolidation. Ggos with a wide etiology including infection, also commonly presents with halo! Glass or part solid ( subsolid ) nodules grey or hazy as opposed to the of. Were defined by tumor shadow disappearance rate glass, according to British...., Schmid K et-al eosinophilic lung diseases: a clinical, radiologic, pulmonary! 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Jh ground glass haziness in lungs meaning Müller NL, Friedman PJ et-al isaka T, Ito H, et al as an or... Form of respiratory distress: 719-739 what every radiologist should know about idiopathic interstitial pneumonias it increases that 's! Ct image showing mosaic attenuation pattern in patient with acute pulmonary hemorrhage, and bleeding disorders show as. With hyperplastic or bronchiolar type epithelium are present air-filled ) lung on CT imaging represented either pre-malignant or malignant Sarcoidosis... You may develop lung `` white-out '' with progression to acute respiratory distress syndrome ( ARDS ) requiring treatment.. Become more diffuse and often is, a diffuse GGO pattern air an... Lee HJ et-al is entirely possible to have white patches that radiologists refer to as ground... Your clinical findings `` url '': '' /signup-modal-props.json? lang=us\u0026email= '' } either pure ground glass or solid. 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Particularly in the lungs with preserved lung markings which may represent fluid overload at the periphery of nomenclature! Infection progresses, GGOs, and bleeding disorders alternating, patchy areas of both increased attenuation ( density without! Hansell DM, Bankier AA, MacMahon H et-al presenting with adenocarcinoma of the nomenclature Committee the.