Review

Ground-Glass
Jannette Collins1
round-glass scribes which lung, cular
spaces.

Opacity

at CT:The

ABCs
in a mosaic pattern airway disease three entiour experience, a current adequate for most patients, requiring increased current. of 250-350 with larger Zwirewich mA is patients et al.

and Eric J. Stern2

opacity a finding (HRCT) increased (GGO) on high-resoluof the lungs attenuation filling partial expiration. volume....Not

C
with margins:

dein of

GGO

can

be patchy,

resulting

tion CT is seen hazy preservation caused alveoli. capillary with

interstitial

pattern of lung attenuation. This mosaic is seen in infiltrative lung diseases, abnormalities, and primary between vascular these [1 2]. The distinction

I 14] evaluated
and conventional

of bronchial by partial thickening. normal blood

and vasof air color to be in which May [1]. radio[2] as a pat-

both low-exposure (20 mA) exposure (200 mA) HRCT, scan time, technique and found that failed to show GGO was

ties can be made by observing the size of the pulmonary vessels in the area of increased lung attenuation (increased and vascular disease, in both airway disease but not in infiltrative disscans (mdiis limited to

both with a 2-sec the low-exposure GGO evident voltage

lapse increased confused

of

in two of 10 cases

in which

consolidation, margins

bronchovascular be associated This finding graphs. described In

are obscured.

ease) and air trapping on expiratory eating airway disease). This review a discussion Pitfalls HRCT of infiltrative processes.

on the high-exposure scans. A kiloof 120-l40and a matrix of5l2 x 512 [5]. Although filming six 14 x 17 inch (36 x 43 cm) recommended

with an air bronchogram is often occult on chest 1989, hazy Klein increased lung disease, appearance and density Gamsu

are recommended images on one sheet of film

has been

15]. we

in the

Interpretation of GGO is based

of GGO

on

prefer to film the images uses fewer pages of film. ment to in the image quality decreasing image to the field of view one lung [15,

12-on-one. which Further improvecan be obtained by and targeting the 16]. Collimation may not caused

tern of diffuse fine granular termed GGO. cific finding, stances indicate guide appropriate it can

referring to the that has been

Recognition tive assessment attenuation

on a subjecAlthough related

of lung attenuation. of the lung is closely

Although GGO is a nonspein certain clinical circumsuggest a specific treatable or diagnosis, disease, surgeon In 1993, to or an

density, which suggests that CT should provide an objective quantifictation of GGO. many and able. parameters make These interfere were with lung density unrelidismore wincreate small for win-

should be 1.0-1.5 mm because GGO be visualized with thicker collimation

a potentially a bronchoscopist area

attenuation parameters

measurements previously

for biopsy.

the sig-

by volume averaging. Furthermore, thicker collimation may result in pseudo-GGO, which, when resolved with thin-collimation HRCT, can be recognized disease. confirmed as linear atelectasis or other obvious GGO should be high-spatial-frequency used, and the scan possible, generally For this reason, on HRCT. A should be as short be as

nificance of GGO was described by RemyJardin et al. [3], and in the same year Engeler et al. [41 published entity. trated The interest [6-11]. by a section a pictorial in GGO in an HRCT essay is further textbook of this illus[5] diag-

cussed by Remy-Jardin et al. [3] and, recently, by Primack et al. [13]. Narrow dow width and level of GGO A recommended and level can erroneously by magnifying range is 1500-2000 the appearance structures. dow width

algorithm time should 1-2 sec.

and six articles

The differential

H and

nosis for GGO is lengthy, which can make interpretation of HRCT frustrating. Because GGO is a frequent finding on HRCT, a simplistic approach to the differential in this review.
after revision

500 to -700 H, respectively [3]. Choosing the correct current is also important. A tube current that is too low will produce excessive noise, current which can mimic mA GGO. Generally, a of 240-400 is acceptable [5]. In

The lung attenuation normally increases with expiration. This increased attenuation can mask disease disease underlying GGO from infiltrative lung or create an appearance if the expiratory nature of diffuse lung of the examina-

diagnosis,

the ABCs,
Received Presented
1 Department

is offered

October 31, 1996; accepted

February 24, 1997. Roentgen Ray Society, Boston, May 1997. Hospital & Clinics, E3/31 1 CSC, 600 Highland Ave., Madison, of Washington, WI 53792-3252. Address correspondence to J. Collins.

at the annual meeting of the American of Radiology, University of Radiology, Harborview of Wisconsin Medical

2Department

Center, Box 359728, University American

Seattle, WA 98104.

AJA 1997;169:355-367

0361-803X/97/1692-355

Roentgen Ray Society

AJR:169, August 1997

355

Collins

and

Stern

tion is not appreciated. tion changes crescent-shaped from round

The tracheal in inspiration

configurato flat or
was

alveolar patients uniform structures

proteinosis. was grey

The

pattern lung with

seen

in all with linear outforms. paving

rhagic

edema

caused

by sudden

occlusion

of lung

of opacified appearance branching geometric triangular.

a diffuse

in expiration

and can be used per-

(ground-glass), pattern of white shapes and square to as crazy and

pulmonary artery flow. Acute lung transplant opacities transplantation in the immediate can

rejection-New period after

to determine whether the CT scan formed in inspiration or expiration. Subpleural electasis opacities caused identified by are frequently

an overlying lining This

lung rejec-

forming polygonal.

be due to infection,

microat-

in the depen-

pattern

was referred

tion. reperfusion edema. or fluid overload. Reperfusion edema is manifested by perihilar interstitial postoperative and alveolar chest opacities on the first This process radiograph.

dent portions of the lungs. These dependent opacities generally consist of reticular, linear, and ground-glass with or mask When distinction opacities and can be confused true infiltrative lung disease. important infiltrative to make lung the disease repeated is in

(Fig. 2). Histologically, the ground-glass cornponent represents partial filling of alveoli with pmteinaceous material ened interlobular septa Acute ease-Acute disease refers chest svndronie chest to the clinical and edematous, of sickle syndrome cell thickdiscell opaciseen

can worsen over several days but generally stabilizes or resolves within 2 weeks. During this period. fusion edema, the differentiation infection, between reperis diffiand rejection

it is clinically between

syndrome

of sickle

and non-disease-dependent

opacities.

of chest

imaging with the patient in the prone position recommended. This procedure will result

pain, fever, prostration, and pulmonary ties on chest radiographs. The opacities

cult both clinically and radiographically. Any new opacities after the immediate postoperative

dependent opacities shifting to the anterior subpleural areas and true infiltrative lung disease persisting in the nondependent posterior lungs. Cardiac and respiratory motion can create pseudo-GGO. which can be distinguished from true GGO by recognizing blurring and double ABCs images of GGO of vessels and fissures.

on chest radiographs and chest CT scans represent pneumonia or infarction due to microvascular occlusion, and clinical between and radiographic causes is usuet al. [23] with acute or paucity of GGO were in geodifferentiation the two

period are suspicious for infection (Fig. 3). After reviewing bronchial biopsies and scans in 32 lung transplant et al. [241 acute documented rejection

rejection or 190 transHRCT Loubeyre of HRCT for this evalu2 weeks only sig-

concurrent patients, a 21% with specific patients The

incidence

ally not possible [21, 22]. Bhalla studied the CT scans of 10 patients chest nine syndrome patients. and found and venules The areas absence and areas of GGO of arterioles

histologically.

being 65% sensitive and 85% diagnosis. The study included ated with to 2 years bronchoscopy after transplantation.

and CT from

A differential diagnosis for GGO is offered that includes disorders that begin with the letters A-G (Table 1 ). The disorders listed they in this have been review included by others commonly were chosen in the because differential

graphic, patchy, and multifocal and confluent with total lobar others and were attributed

in some cases involvement in to early hemor-

nificant HRCT finding in acute rejection was GGO. seen in 65% of patients with rejection, which was patchy and localized in mild rejection and widespread was always present of acute rejection rejection. represents in severe rejection. in the most severe The GGO seen an alveolitislike GGO grades in acute process.

diagnosis of GGO and because they

in the literature result in GGO

as the sole manifestation of the parenchymal process or as a dominant finding on HRCT. Because GGO can represent either interstitial or alveolar processes, beyond the resolution of the HRCT differential diagnosis A Alveola, proteinosis filling pt-oteiiiosis.-Pulmonary is a disease alveoli by a periodic alveolar in acidof the lung that results technique is long the complete (Fig. 1).

On histologic samples of acute rejection, extension of the inflammatory cell infiltrate into perivascular and peribronchioloalveolar septa and air spaces occurs, especially when the grade ential of rejection is high. group The main differis which diagnosis in this (CMV) of patients

cytomegalovirus can have an identical Adult espuatorv respiratory terized distress distress caused by by refractory

pneumonia,

radiographic appearance. distress syndrome-Adult syndrome hypoxemia nonhydrostatic (ARDS) is characpulmonary and respiratory

in of the

Schiff-positive proteinaceous lipid [17, 18]. The underlying lated to be dust (particularly or an immunologic disturbance AIDS or other immunodeficiency, logic and lymphatic malignancy,

material rich in cause is specusilica) exposure (caused hematoor chemotherby

edema (Fig. 4). Leaky capillary membranes lead to extravasation of protein-rich fluid into the interstitial and alveolar spaces of the lung, leading to a decrease in normally inflated lung volume and a decrease in lung compliance. Numerous precipitating factors are known, including tion, have aspiration, contusion, smoke inhalaand sepsis. Patients surviving ARDS can little pulmonary sequelae but may develop

apy). Superinfections occur, most notably with nocardiosis 1191. In 1988. Godwin et al. 1191 described pulmonary air-space the CT features alveolar opacity of nine patients with proteinosis. All patients had on CT (not differentiated and the authors pattern was freMurch CT pulmonary a characteristic with

as to GGO or consolidation), reported that an interstitial quent and and Carr sometimes [20] described patients in six

severe lung fibrosis. The true rate of conversion of ARDS to interstitial fibrosis is unknown because formed patients transporting follow-up [251. CT critically with ARDS lung biopsy is seldom because ill patients is so rarely used of the difficulty to the radiology perin to examine

predominated.

appearance

356

AJR:169, August 1997

Fig. 1.-Diagrammatic representations of different causes of ground-glass opacity (GGO) on CT chest scans. Each box represents a pixel on a CT scan. Diagrams highlight nonspecific nature of GGO. A, Pixel contains normal lung parenchyma at full inspiration with normal alveolar walls and alveolar air spaces. Normal amounts of air, blood, and tissue in pixel will yield a certain expected Hounsfield attenuation and will be assigned gray-scale value (e.g., -800 H). B, Pixel shows thickening of interstitium of lung, which may result from either inflammatory or fibrotic response to insult (e.g., alveolitis or microfibrosis), which in turn creates more tissue per pixel relative to air, thus increasing the Hounsfield value assigned that pixel (e.g., -650 H). C, Pixel shows fluid filling alveoli (e.g., edema), again increasing Hounsfield value assigned that pixel. D, Pixel shows normal parenchyma at end of exhalation. Note increased number of alveolar walls per pixel and less air than in A. Results include increased gray-scale values.

Fig. 2-37-year-old

man with pulmonary alveolar proteinosis.

High-resolution

CT

scan shows ground-glass opacity of alveolar spaces and thickening of interlobular septa with no architectural distortion. Note typical polygonal shapes called crazy-paving. Also note sharp demarcation from surrounding normal lung tissue, creating geographic pattern.

Fig. 3-38-year-old man 23 days after bilateral lung transplantation for idiopathic pulmonary fibrosis with acute lung transplant rejection. High-resolution CT scan shows bilateral patchy ground-glass opacity and interlobular septal thickening (long arrows). Right bronchial anastomosis is normal, without stricture or dehiscence,

and small indentations anteriorly and posteriorly result from telescoping technique of surgical anastomosis (short arrows). Transbronchial biopsy revealed bronchiolitis obliterans organizing pneumonia, mild rejection, and no active infection.

Collins

and

Stern

uted nary around

in a uniform hemorrhage a focal

fashion septal can occur

common

with

GGO

and interlobular

thickening

[29]. Pulmoof GGO (Figs.

as a halo consolidation

area oflung

6 and 7). This ground-glass halo was reported by Kuhiman et al. [30] to be a clue to the diagnosis of early invasive pulmonary aspergillosis in leukemic that
ring

patients.

Those

authors

speculated peripheral infarction to the

the pathologically identified of hemorrhage or hemorrhagic

target

surrounding CT halo pulmonary r.

Primack

lesions

corresponds

zone of GGO aspergilosis

surrounding invasive lesions on CT scans.

et al. [31] reported several infectious and noninfectious causes of the CT halo sign, including metastases of these from more halo hemorrhagic of a halo recently with representing and researchers nonhemorrhagic of GGO described Kaposis showed nodules (Figs. cause sarcoma. that in by can be disnodules 8 and 9). of focal groundis the study patients

Fig. 4.-37year-old man after recent resection of intracranial neoplasm who developed acute respiratory failure and adult respiratory distress syndrome requiring prolonged intubation. High-resolution CT scan shows bilateral diffuse mixed consolidation and ground-glass opacity, pneumatocele (arrows) and small cystic spaces caused by barotrauma, and bronchiolar dilatation.

The most

tinguished the presence Another

department. CT scans observed dependent respectively). 8% incidence [27] studied

Tagliabue of lung 74 opacities These

et al. [26] patients with that were

reviewed ARDS bilateral

only

the and and

an

Blood-Pulmonary fuse, patchy, ing cause tures cause. or focal,

hemorrhage depending

can be difon the underlythat

GGO, glass

or nodule

a surrounding hemorrhage,

in most of the patients researchers of (1(30. the serial

(92%
reported

and 86%,

Pulmonary-renal hemorrhage Wegeners

syndromes

Likewise, Owens et al. changes in the appear-

pulmonary syndrome,

include Goodpasgranulomatosis.

pseudonodule lung biopsy described reviewed undergone

resulting from transbronchial (Fig. 10). This pseudonodule was by Kazerooni et al. [32], who 141 CT scans in 40 patients who had lung transplantation and transbron-

ances of the lungs on CT scans in eight patients with ARDS. Early in the course, all patients had (1(30 on CT, which persisted on follow-up CT in 50% of patients. parenchymal distortion, solidation, and reticular Other findings included multifocal areas of conand linear opacities. On

systemic lupus erythematosus, Henoch-Sch#{246}nlein purpura, mixed connective-tissue disease, and other vasculitides. Some of these processes also occur without renal disease. Other causes of pulmonary hemorrhage include intravascular leukemia, anticoagucoagulaacute lung lant use, disseminated tion, thrombocytopenia, (ARDS, ity), aspiration
injury

chial biopsies. These researchers found nodules representing biopsy-related injury in 30% of the studied patients and concluded that when these nodules are detected of transbronchial biopsy, injury in addition allograft rejection Bronchiolitis nia.-Bronchiolitis acterized granulation within a few weeks biopsy-related lung and

follow-up scans, clearing of consolidation occurred in all patients, but (1(10 persisted in four of eight patients. This persistent (1(10 probably represented interstitial thickening (by edema, inflammatory cells, or fibrosis), partial filling of the air spaces, or a combination of the two.

toxic inhalation, oxygen toxicof blood, drug toxicity, blunt or and mitral HRCT scans stenosis show [28]. In consolidaphase, distrib-

to pulmonary infection should be considered. obliterans obliterans organizing is a disease

penetrating the acute

trauma,

pneumochar-

phase,

tion or (1(10 (Fig. CT scans will show

5). In the subacute 1- to 3-mm nodules

histologically tissue plugs

by the presence of that occupy and often

Fig. 5-25-year-old man with diffuse alveolar hemorrhage who underwent ablative chemotherapy, total body irradiation, and allogeneic bone marrow transplantation for multiple myeloma and then developed acute respiratory failure requiring mechanical ventilation and eventual tracheostomy. A, CT scan obtained 25 days after transplantation shows bilateral patchy ground-glass opacity (GGO) correlating with bronchoalveolar lavage findings of blood only (no evidence of infection). B, CT scan obtained 18 days after A shows increased bilateral COO, small cystic areas bilaterally (representing pulmonary interstitial emphysema), and pneumomediastinum (arrows) due to barotrauma, all of which correlate with clinical diagnosis of adult respiratory distress syndrome.

358

AJR:169, August

1997

occlude ducts the When

respiratory (Fig. lung

bronchioles parenchyma

and

alveolar obliterans, is normal. into the bron-

11). In pure bronchiolitis obliterans pneumonia centriacinar obliterans alveoli, organizing [33J. Although

surrounding bronchiolitis

is accompanied extending the term

by organizing surrounding chiolitis (BOOP)

pneumonia bronchiolitis in many cases gases. infection. transplanta-

is applied

results from a specific cause (exposure to fumes and toxic connective-tissue diseases,

organ

tion). BOOP (also referred to as cryptogenic organizing pneumonia) is commonly idiopathic

Fig. 6.-8-year-old boy with invasive pulmonary aspergillosis who was treated with chemotherapy for acute myelogenous leukemia. CT scan shows consolidation of right lower lobe, with halo of ground-glass opacity. Biopsy of mass confirmed diagnosis of invasive aspergillosis. Fig. 1-62-year-old man with invasive pulmonary aspergillosis 3 months after orthotopic hearttransplantation. High-resolution CT scan shows bilateral upper lobe masses with ground-glass halos (arrows), correlating with histologic diagnosis of invasive aspergillosis.

(Fig.

12). Clinically. illness cough, malaise, clinical and

BOOP with

usually and loss With fever,

presents symptoms expecBOOP [34]. steroid

as

a subacute including toration, may ment,

signs

dyspnea,

sputum

and weight radiographic

resolve

spontaneously.

treatclear in

signs

with metastatic melanoma involving multiple organ systems. High-resolution CT scan shows multiple well-circumscribed nodules with surrounding halos of ground-glass opacity representing hemorrhage. Many nodules are cavitary, an unusual finding in malignant melanoma (arrows).

Fig. 8-63-year-old-woman

man with AIDS and Kaposis sarcoma. High-resolution CT scan shows irregular opacities in bronchovascular distribution (long arrows) with surrounding ground-glass opacity (660) (short arrows) and interlobular septal thickening (curved arrows). 660 and dependent atelectasis at left base creates false appearance of bronchiectasis.

Fig. 9.-34-year-old

Fig.

10-62-year-old woman with postbi-

opsy nodule 3 months after right lung transplantation. High-resolution CT scan obtained 1 week after right upper lobe biopsy shows nodular opacity (long arrow) with surrounding halo of ground-glass opacity (short arrows), representing postbiopsy hemorrhage. Histology showed no evidence of infection or rejection, and nodule resolved without treatment, as shown on follow-up CT scan 2 months later.

Fig. 11-50-year-old man with bronchiolitis obliterans and worsening pulmonary function tests 17 months after bilateral lung transplantation. High-resolution CT scan shows ground-glass opacity with airway distribution on left (long arrows), peripheral distribution on right, and bronchiolectasis (short arrows). Transbronchial biopsy confirmed diagnosis of bronchiolitis obliterans and mild interstitial fibrosis, but no acute rejection or infection was diagnosed. Bronchiolitis obliterans in this patient population represents chronic rejection.

Fig. 12-69-year-old woman who developed acute respiratory failure caused by bronchiolitis obliterans organizing pneumonia. High-resolution CT scan shows focal areas of consolidation and ground-glass opacity in peripheral distribution involving only right lung.

Collins

and

Stern

most patients patients will patients of patients ment. HRCT patients sharply GGO will

in days or weeks, but have persistent disease, die. and approximately one on withdrawal Itoh biopsy HRCT areas distribution. findings scans

some some third the

300 ml of normal saline (in 20 ml aliquots) through a bronchoscope wedged into the lingular aspirated laboratory. mediator and specific segmental HRCT recent observed or middle back cells where are proteins or lobar lobe into bronchus. the scope inflammatory identified are distribution Fluid and and analyzed sent and is then to the immune counted

minimal fibrosis, and hyperplasia of alveolar lining cells. RB-ILD resembles desquamative interstitial can be the basis pneumonitis distinguished of the distribution pathologically from that disease of inflammatory but on

will relapse and lung BOOP.

of treatof eight showed or Histologi-

Nishimura and open with demarcated

[35] compared

[391. A
of GGO on of if lung is a

changes at the bronchiolar and alveolar level [40]. In RB-ILD the abnormalities are patchy, monitis C
CAIV

of consolidation

and they

in desquamative are more extensive

interstitial

pneu-

in a panlobular

cally. the inflammation

GGO represented alveolar septal and alveolar cellular desquamagranulation In some tissue of the in the terspecimens.

should suggest bronchoalveolar in the right

the possibility lavage. especially lobe [3]. inteistitial bronchiolitis-associdisease (RB-ILD)

and diffuse.

middle

tion with a little minal air space. interlobular a boundary. sharp their able chronic diagnosis suggested margin experience eosinophilic on HRCT.

Bronchiolitis-associated disease-Respiratory ated interstitial lung

Infectious fest

pneumonia pneumonia

and othe, infections.of any cause can mathscans (Fig. 13), but cainii is recto in 49of is in

septa or pulmonary veins formed accounting for the presence of a and panlobular These authors BOOP distribution also reported is often and pneumonia, clinically although can blood indistinguishfrom the be or seen that in

as GGO

on HRCT

diagnosis based on the combination of clinical evidence of interstitial lung disease and restrictive ties and lung in cigarette pulmonary respiratory smokers function bronchiolitis cases [40-42]. Holt abnormalishown on have occurred et al. [43]

CMV pneumonia and Pneumocvstis pneumonia are often emphasized. CMV ognized cause patients as the most substantial with AIDS: common morbidity and

viral pathogen mortality studies,

radiographically

biopsy.

All reported

in autopsy

of eosinophilic pneumonia with eosinophilia in the lavage fluid. MUller that the major CT pattern

described the HRCT findings with biopsy-proven RB-ILD.

in five patients HRCT scans of GGO that the preOther intralobuthickening. con-

81% of patients CMV infection also a relatively

with AIDS have evidence [44, 45]. CMV pneumonia common complication

bronchoalveolar [10] suggested BOOP

and Miller feature of with a pre-

three of the five patients showed was extensive and that constituted dominant finding in two patients. abnormalities included lar and interlobular and cluded coarse detectable scans emphysema. from bands atelectasis. interstitial

is a ground-glass

organ transplant recipients that can lead to respiratory failure and death (Fig. 14). McGuinness et al. [46] retrospectively evaluated CT scans, results bronchoalveolar of 21 patients lavage, and biopsy with AIDS and cyto-

dominantly subpleural distribution in about half the cases. CT and HRCT findings in patients with BOOP include GGO (seen in 875Ck of patients). nodules, or areas of consolidation with a predominant peripheral. bilateral. and nonsegmental B,o,ic/ioalieolar lar lavage
monary

These

researchers

their small series that GGO or of atelectasis may be the only abnormalities with RB-ILD. a on HRCT Histopathomac-

pathologic evidence of CMV infection without other infections. CT findings included GGO (nine of 21 patients), thickening reticulation
pathology

dense

consolidation,

distribution used
is used

[36-38]. to diagnose pulby pulmonary of disdiagnosis and The recomof 100-

pulmonary

lavage.-Bronchoalveoand

in patients

bronchial wall and interstitial disease.

scans for whom

or bronchiectasis. without air-space with GGO on CT

were specimens

is a procedure
diseases

logic findings consisted rophages arranged in distribution and adjacent within alveolar

of pigmented
bronchiolocentric

Of the five patients

investigators

studying

the pathogenesis to improve of prognosis. involves

ease in an attempt identify predictors mended technique

respiratory ducts and

bronchioles alveoli: and

showed

available, logically.

all showed air-space The air-space filling macrophages, proliferating

filling histoconstituted a fibrin, reactive hyaand

injection

alveolar septa in involved infiltration with chronic

areas often inflamniatory

cells,

mixture of alveolar line membranes,

-.

Fig. 13-33-year-old man with hemoptysis caused by blastomycosis. High-resolution CT scan shows focal consolidation with surrounding ground-glass opacity in medial segment of right lower lobe (long arrows) and smaller foci of nodular and branching opacities peripherally (short arrows), consistent with endobronchial spread of blastomycosis.

Fig. 14-42-year-old-man with cytomegalovirus (CMV) pneumonia who underwent ablative chemotherapy, total body irradiation, and allogeneic bone marrow transplantation for acute myelogenous leukemia. High-resolution CT )HRCT) scans and lung biopsy were performed 3 days after transplantation when patient developed acute respiratory symptoms. HRCT scan shows bilateral patchy areas of ground-glass opacity and bronchiolar dilatation. Histology revealed interstitial pneumonitis and CMV infection.

360

AJR:169,

August

1997

Ground-Glass

Opacity

at CT

sloughed rhage. described in reported a mixed some Kang patients out other reported consisting

pneunlonocytes. In another of and study. the CT findings the most alveolar frequent

and Aafedt of CMV

old

hemor[47] and to be with

ance consist debris; stitium

on microscopy of surfactant,

and

that fibrin,

was and

known cellular inter-

to

cluded carcinoma,

that

in a focal

a patient small

with nodule

known of GGO

lung must

et al. patients pattern

pneumonia

a population

non-AIDS interstitial

and thickening of the alveolar by edema and cellular infiltrates. and lymphoprolftiatiie primary lung neoplasms areas of consolidation, Bronchioloalveolar

be investigated to rule adenoma or multicentric Intrathoracic ders, AIDS from seen and benign

out bronchioloalveolar adenocarcinoma. disorwith range to

CT appearance

Cancer de,s.-Most masslike cavitation.

diso,-consist of a most nod-

lymphoproliferative predominantly in patients other immunocleficiences. lymphoid cell hyperplasia

peripheral predominance. More recently, et al. [48] studied 10 organ transplant who underwent proven associated of small chest CMV infections. nodules, CT and who had pneumonia Those withauthors

with or without carcinoma,

pathologically

type of bronchogenic adenocarcinoma, commonly presents as a solitary peripheral ule but can also present on HRCT GGO scans reflects the unique as a focal lepidic [52] (Fig. 16). Such along

malignant lymphoma. Carignan et al. 1561 studied the chest CT scans of 12 patients with pathologically disorders hyperplasia. nia, proven (AIDS-related lymphocytic lymphoproliferative diffuse interstitial lymphoid pneumo-

area of (1(30 an area of pattern the alvegrowth

the CT findings

to be heterogeneous, consolidation.

GGO (four patients). logically, the GGO

of

and irregular lines. Historepresented early changes damage. three been Because of the seven), ca,inii pathogen (Fig. 15). HRCT patients the prespneuin the Kuhlin

of bronchioloalveolar

carcinoma

posttransplantation

lymphoproliferative

diffuse

alveolar

olar septa Follow-up with replacement represent carcinoma

with relative lack of acinar filling. CT scans in three of four patients carcinoma by consolidation, of (1(30 of bronchioloalveolar adenocarcinoma along intact of growth showed leadmay of the GGO an early stage pattern

disorders, and areas of GGO hyperplasia phocytic four patients proliferative cumscribed

lymphoma) and found diffuse in the patient with lymphoid three patients with Three lymof the lymphowell-cira halo of pneumonia.

was ence

performed of GGO

in only may have

bronchioloalveolar

and the interstitial

(conventional

CT in the other

underestimated.

ing to speculation

that the areas Metastatic

P. carinii pneumonia-P. monia is another common immunocompromised man et al. [49] reviewed host

with posttransplantation disorders had multiple, pulmonary nodules the halo arranged with

[52].

can have a lepidic alveolar walls olar carcinoma

the CT findings

39 patients with P. ca-inii pneumonia and reported three patterns of involvement: (1(10 (26%), a patchwork pattern consisting of mixed interstitial and alveolar disease (56%), and an interstitial pattern report, Sider et al. [50] scans of patients with that the presence infiltrate without proper of P. examined clinical carinii the (18%). studied AIDS and In another chest CT reported

similar to that of bronchioloalveGaeta et al. [53] retrospectively

GGO. Histologically. represent less densely

was found to B cells that

reviewed CT scans of 65 patients with proven lung metastasis from gastrointestinal carcinomas. Six of 65 patients Bronchioloalveolar had air-space showed adenoma disease, evidence of the to be a or potenand is usually examiand five of these of (1(30. lung highly tially is considered differentiated malignant benign incidentally six patients

extended into the surrounding interstitium. The predominant finding in two patients with AIDS-related lymphocytic interstitial pneumonia areas diffuse Another HIV the was the presence histologically lymphocytic the in nine and finding chest comparing findings or AIDS found CT of diffuse bilateral a and with to be one infiltrate. CT patients nodules of GGO study representing

interstitial

histopathologically adenocarcinoma neoplasm at microscopic

of an isolated ground-glass additional findings in the setting was scans highly Bergin of suggestive et al. [51] 14 immuno-

histopathologic infection predominant tive disorders

lymphoprolifera-

discovered

2- to 4-mm

pneumonia. HRCT

nation of surgically resected lung specimens [54]. Kushihashi et al. [55] studied the CT scans of 668 patients with lung cancer and found nine small ground-glass nodules, seven of which were subsequently shown to represent bronchioloalveolar adenoma. These researchers con-

1571. Only

compromised patients P. carinii pneumonia: histologic fluid within features alveoli

with histologic proof of all showed GGO. Two accounted for the GGO: that was foamy in appear-

patient had evidence of GGO without nodules, which histologically represented a nodular pattern of interstitial lymphocytic infiltrate. disCollagen vascular disease-Collagen vascular disease is a chronic multisystem

,,,

Fig. 15-39-year-old man with AIDS and Pneumocystis cariniipneumonia. High-resolution CT scan shows multiseptated cavitary lesion in right upper lobe (arrows) and patchy ground-glass opacity bilaterally.

man with bronchioloalveolar cell carcinoma. CT scan shows bilateral patchy lung disease most pronounced in right lower lobe and left upper lobe. Note multiple ill-defined nodular areas of ground-glass opacity scattered throughout lungs around pulmonary centrilobular-sized bronchioles. Anterior portion of lingula is densely opacified.

Fig. 16-60-year-old

AJR:169,

August

1997

361

Collins

and

Stern

ease fibrosis,

characterized and

by

vascular the vascular pneumonia.

changes, tisrespiratory of the lung diseases diffuse

inflammation

of connective

sue. All types may involve system. Specific abnormalities associated include with usual collagen interstitial

alveolar damage, BOOP. pneumonia, and lymphocytic monia. scans patients including Johkoh and with et al. [58] collagen pulmonary progressive

cellular interstitial interstitial pneuevaluated tests sclerosis, vascular HRCT in 55 disease, sysand and idio-

function systemic

temic lupus erythematosus, polymyositis dermatomyositis. rheumatoid arthritis, Sjogrens ings with syndrome. those and compared of nine patients fibrosis. 000 with progressive with systemic rheumatoid syndrome. with polymyositis was lupus with

Fig. 17.-i

the findseen in systemic erythearthritis. The mci-

2-year-old boy who developed pulmonary contusion after motor vehicle accident. CT scan of chest shows ill-defined nonanatomic peripheral areas of ground-glass opacity and consolidation. No evidence is seen of underlying pulmonary laceration or other intrathoracic injury.

pathic pulmonary 89% of patients sclerosis, matosus, myositis. and 63% 100% 71%

in

10-14

days (Fig.

without 17).

CT

or

radiographic

and dermato-

sequelae
D

dominantly peripheral ground-glass idated opacities that occasionally nodular or masslike.

inteistitial

or consollooked

l007c with with Sjogrens

dence of GGO in idiopathic pulmonary fibrosis was the same as in collagen vascular disease: systemic ated in collagen pulmonary reported with patients but with the exception of progressive sclerosis, the incidence of associwas disease significantly than lower vascular fibrosis. the HRCT rheumatoid (49%) had in idiopathic

Drug

toxicity-Pulmonary

toxicity

has and a pro-

Desquainative Desquamative

interstitial

pneunioniris.pneumonitis was first

been associated with numerous drugs. variety of pathophysiologic mechanisms ducing graphic
drug

described by Liebow et al. [66] in 1965, who characterized the condition by the presence of relatively mild respiratory symptoms, mild fibrosis of alveolar septa, and a cellular infiltrate in the alveolar air spaces (now known to be macrophages). the HRCT logically monitis. HRCT.
peripheral

honeycombing

lung injury results in varying radioand CT patterns. Early recognition of toxicity with may and allow reversal of the lung agent. on the withdrawal Gefter of the inciting 1631 reported

Remy-Jardin et al. [59] findings of 77 patients arthritis. CT scans Thirty-eight showing bron-

injury common toxicities, diffuse opacities. inciting produce disease,

Hartman findings

et al. [67] reported with interstitial zone (73%)

on pneuon and

Aronchick

of 22 patients had areas lung

patho-

radiographic including

patterns of specific drug diffuse alveolar opacities,

proven with

desquamative a lower

All 22 patients
(59C/c)

of GGO

chiectasis or bronchiolectasis (30% ), pulmonary nodules (22%). subpleural micronodules or pseudoplaques (17%). nonseptal linear attenuation honeycombing
Contusion-Pulmonary

interstitial opacities, focal alveolar and pulmonary nodules. The list of agents is long. and many drugs can more but than one pattern representative of parenchymal CT scans show often and

distribution

predominating.

(18C/c),

areas

ofGGO

(14%),

and a con-

Reticular sis were

lines. cysts. and traction bronchiectaless frequently seen findings. The pre-

(10%). contusion.

dition implying bleeding into the air spaces and interstitium of the lung without major disruption of lung architecture, is generally accepted as the primary lung injury following blunt chest trauma. Pulmonary usually caused by a compression cent to the site of chest a peripheral CT appearance defined areas out segmental peripheral tally induced distribution of lung of GGO distribution contusions, wall injury, of lung contusion is injury adjaresulting opacity. in The

nodular areas of GGO and consolidation, with a peripheral distribution. Typical

dominant histologic lesion was filling of the alveoli with macrophages. Desquamative interstitial pneunionitis is a distinct form of interstitial pneumonia

unique features of amiodarone (an iodinated compound used to treat life-threatening yentricular dysrhythmias) lung toxicity are pleural-based wedge-shaped tion areas of consolidation adjacent
to the pleura.

clinical nia. Other interstitial pneumonia.

course

characterized than usual

by a more benign interstitial pneumo(lymphocytic cell interstitial interstitial et al. [66],

high-attenuaor focal atelecta.sis attenuation in of a in

interstitial pneunionias pneumonia, giant bronchiolitis as classified

obliterans by Liebow

The high

pneumonia). can
niack nine show

contusion is that of illor consolidation withbut usually Schild with a [60. 61]. ln experimenet al. 162] to chest radiogcontusions. In contusions after trauma, contusion whose CT pulmonary is scan con-

these lesions is due to the concentration iodine in the lung parenchyma. Bleomycin. chemotherapeutic treating lymphoma nonseminomatous tes, has also been nary toxicity, pleural-based solidated rospectively patients lowed
gous

similar radiographic features. Priet al. [681 described the HRCT features in
with biopsyor autopsy-proven

agent

used

routinely

patients

distribution

and seminomatous and germ cell tumors of the tesreported to produce pulmonianifests as (1(10 or confindings toxicity and in 20 that fbIautoloscans pre-

acute
ously

interstitial
known as

pneumonitis, Hamman-Rich
pneumonia.

an entity and

varidiffuse

syndrome.

accelerated

interstitial

showed that CT was superior raphy in detecting pulmonary their were study. visible

which on CT linear and nodular evaluated the CT drug

alveolar damage. Bilateral symmetric areas of GGO were present on the CT scans of all nine patients. thickening
cells.

100% of pulmonary on CT immediately that pulmonary

irregularities with pulmonary

[64]. Patz et al. 1651 ret-

which
fibroblast

correlated
proliferation,

histologically

with

of the interstitium

suggesting

by inflammatory and edema, with damage and hyaPark et al. 1691 in seven patients

unlikely in a trauma patient shows normal findings. Most

tusions

high-dose

chemotherapy

start to resolve

within

72 hrs and clear

bone marrow transplantation. CT of 13 patients (65/c) showed scattered.

evidence of diffuse alveolar line membrane formation. described the HRCT findings

362

AJR:169,

August

1997

Ground-Glass with pathologically proven nonspecific interstiand pathopneumonia pneumonitis. and depending the quantity [71] correlated malities function acute
tis.

Opacity

at CT of exposure Hansell and et al.

on the periodicity of inhaled the pattern results common antigen. scans

and patchy Eosinophilic nophilia diseases gillosis:

monary

air-space occurs such

consolidation

(87%). eosior asperpulfungal,

dis-

tial pneumonia.
logic (distinct desquamative entity

a distinct clinical of idiopathic interstitial acute interstitial interstitial

pneutnoiua.-Pulnionary in a variety as of conditions bronchopulmonary granulomatosis: including

collagen

and extent

of abnorwith subwere

from

seen on HRCT test most and chronic

with pulmonary pneumonipatterns perfusion (55%), and of decreased

pneumonitis,

in 22 patients hypersensitivity HRCT and mosaic small nodules (36%). Areas

bronchocentric infections
sarcoidosis:

usual interstitial with subacute

good prognosis

pneumonia), which manifests or chronic dyspnea and has a

with corticosteroid therapy.

bacterial,
vascular

The

and helminth
fibrosis:

infections;

idiopathic syndrome: Hodgkins

these

pulmonary Churgand pulunderlying

These HRCT GGO lated

researchers found the most findings to be bilateral patchy with or without

histologically

common areas of that correinflanima-

decreased attenuation (86%), GGO (82%). a reticular pattern

eases; Strauss drug

hypereosinophilic syndrome:

disease:

consolidation with interstitial

attenuation correlated with ping indicated by residual (1(10 dently and with other feature reticulation restrictive diffuse in lung lung subacute

severity of air trapvolunie. whereas correlated function. although indepenHansell seen is a domiwith in

reactions 1741. When diseases or specific causes

are excluded,

tion and fibrosis.

monary eosinophilia is classified either acute or chronic. Chronic pneumonia

areas scans, improvement

as idiopathic. eosinophilic dense and CT

rapid and possi-

E E.vt,-insic
allergic alveolitis is a complex primarily

et al. concluded many alleigic

or

that GGO,

is characterized on chest
clinical steroid with persistent

by multiple radiographs
course. therapy,

diseases, pathologically

of opacity

alveolitis.-Extrinsic
hypersensitivity pneu-

nant by

hypersensitivity

pneumonitis.

correlating

monitis
the lung,

immunologic
to inhaled organic

reaction
antigens.

mononuclear cell infiltration of the alveolar walls. In another study attempting to establish whether pneurnonitis sis, HRCT patients CT can distinguish hypersensitivity from idiopathic pulmonary fibroscans showed widespread GGO in with idiopathic pulmonary fibrosis interstitial pneumonia. from some cases of acute or pneumonitis 172].

ble relapse. pneumonia and

neous

In contrast. is characterized on chest

onset with during

acute eosinophilic by diffuse GGO radiographs

high fever. hospitalization.

although inciting mon farmers mycetes from sugar

noninhaled agent. The and

drugs can most important their inciting

also be an and comagents are

micronodules acute
improvement

and
sponta-

CT scans, rapid

disorders

lung from thermophilic actinoin moldy hay (Fig. 18). bagassosis

The,-nzoactino,nvces sacchaii in moldy

improvement (Fig.

if treated 19). The on (1(10

with steroids, appearance HRCT

along

and

and desquamative indistinguishable subacute

no relapse eosinophilic described

of acute has
the

pneumonia as peripheral

been
bron-

cane,

mushroom

workers

lung

from

hypersensitivity

thermophilic actinomycetes in mushroom compost. ventilation pneumonitis from T. vulgal-is (among workers lung
moldy barley,

Akira et al. [731 studied the HRCT scans of 15 patients with summer-type hypersensitivity pneumonitis. ring only toms appear spontaneously an immunologic in Japan in in which the summer in mid autumn. disease the clinical occursymp-

chovascular bundles correlating histologically with edematous interstitial tissues with scattered eosinophil infiltration filling [75]. In a study of pathologically chronic common adjacent proven eosinophilic and
17

others) in dust from Aspeigillus

and bird fanciers

or mist, malt clavatus in

(breeders)

no
patients

alveolar
with

lung

from

avian

protein

in droppings

and

and subside HRCT find-

or clinically pneumonia,

diagnosed the most usually with a

feathers [70]. The clinical presentation may be categorized as acute, subacute, or chronic,

ings included diffuse slightly elevated lung

micronodules (100%), density or GGO (87%).

HRCT finding was GGO, to areas of consolidation,

Fig. 18-50-year-old

farmer with 3-month history of cough and shortness sulting from hypersensitivity pneumonitis. High-resolution CT scan shows of ground-glass opacity, correlating with clinical and histologic diagnosis persensitivity pneumonitis (farmers lung).

of breath repatchy areas of acute hy-

Fig. 19.-li-year-old man with acute onset of wheezing, shortness of breath, and fever resulting from acute eosinophilic pneumonia. Eosinophil count was markedly elevated in bronchoalveolar lavage fluid and in peripheral blood, and patients symptoms resolved with steroid treatment Before steroid treatment, patient had no improvement in symptoms with bronchodilators. High-resolution CT )HRCT) scan shows bilateral patchy ground-glass opacity in bronchovascular distribution and airway dilatation (arrows). Airway dilatation resolved on follow-up HRCT. Extensive workup revealed no evidence of primary cause of eosinophilic pneumonia.

AJR:169,

August

1997

363

Collins

and

Stern

peripheral of chronic intraalveola.r cytes

uid.

distribution eosinophilic exudate

occa.sioiially. interstitial

76]. Histologic pneumonia of eosinophils.

anorphous infiltration pulmonary

studies show
material,

F and G

interstitial

tissue

or

microcystic

honey-

an

Fihrosis.-000 extensive minimal nostic assessing alveolitis, findings nary

in

can

be

a reflection

of

comb

histioI 77].
edema

lung parenchymal fibrosis with alveolitis [3]. To evaluate the progimplications of 000 at HRCT in response to treatment of fibrosing Lee et al. (79] correlated HRCT with the improvement
values

pattern on HRCT [3]. Like Remy-Jardin et al. 1801. Wells et al. 181 1 found that the prognostic significance of 000 on CT depends on the extent of an associated reticular pattern and is independent of the extent and distribution ofdisease. Furthermore, fine the may but in with intralobular fibrosis, limits of resolution not be depicted might lung usual
with

afl(.l eosinophilic Edena.-Cardiogenic

is the consequence

of high

pulmonary

capil-

lary and venous pressure due to failure of the left side of the heart, with edema fluid collecting or in the alveolar spaces. of the interstitial two. Identical spaces. CT a combination

in pulnioby the increase

on pulnio-

function function

as represented tests after

which lies below of the CT scanner, abnormality increase amorphous of volume studied
interstitial

percentage-predicted

as a reticular in an because

nary

corticosteroid

ther-

result density interstitial

desquamative

findings can he found of cardiac or noncardiac occur in all situations of the lung lympluttics transudate is exceeded, an(.l lyniphatic lary permeability. Storto et al. ings of seven
disease

in pulmonary edema origin. Edenia can

iii

apy. These researchers of 000 at HRCT response to treatment Subsequently, ied 26 patients ease (desquamative usual interstitial

found that the presence is a good predictor of in fibrosing alveolitis. et al. [80] studdiffuse lung dispneumonitis. sarcoidosis,

averaging. 1 1 patients pneumonitis HRCT and

Hartman

et al. (82]

12 patients and

which to drain

the capacity
capillary venous

pneumonitis and follow-up

induding

Remy-Jardin with chronic interstitial pneumonitis,

who

had

initial

obstruction, increased and hypoproteinemia 781 described the HRCT patients thought to have

capil3]. findlung

foun(1 that pneumonitis.

in extent

in patients with areas of 000

or progress to fibrosis

usual interstitial usually increase

despite treat-

BOOP. hypersensitivity scleroderma) who had 000 as abnormality eycombing. 000 were

pneumonitis. and extensive areas of

who

hydrostatic of clinical abnormalities

diuretics.

subsequently pulmonary history and on radiology

had a diagnosis of edema on the basis the resolution after therapy

visible on

the predominant or exclusive at HRCT in the absence of honIn this patient group. found to be a reliable areas of indicator

merit, and areas with desquamative reniain matous

will focus

of

(100 in most patients interstitial pneumonitis with known.

one

stable

or improve are
sarcoidosis.

treatment. This
of

Abnormalities

of with HRCT

Granuloinatous

disease-Many

diseases
on

granuloreview
the most

scans

included
septal

areas

of (100 interstitial

(six
(five

patients),
patients),

of inflammation, signs of fibrosis eycombing. ease

CT

but only in the absence of such as bronchiectasis or honassessment possible

or complete

common Sarcoidosis unknown

disorders

in this

class

of diseases.

interlohular

thickening

Retrospective remains
when decreased

of disreso-

perihronchovascular (five (tbur patients), patients). and

thickening caliber or thickThe 0(10

geographic,

activity
scans

on follow-up

is a multisystemic cause characterized granulomatous various

to involve The

disorder of by the presence inflammation of the body.

respiratory

increased pleural (four

or patchy

vascular effusion
and

of noncaseating that can affect

a propensity (Figs. 22-24).

lution

of 000

is observed. persistence indicates of 000 fibrosis after ste(Fig. 21).

sites
the

with
tract

ening of fissures can appear diffuse

patients).

Conversely, roid treatment

cellular

and

granuloma-

often with a gravitational predominance that is thought to represent minimal thickening of the pulmonary interstitium. intraalveolar fluid layering against the alveolar walls, or a transient increase in the pulmonary blood volume (Fig. 20). capillary

When follow-up CT scans show sequential replacement of 000 by typical honeycombing. the initial CT findings may correspond to pathologic changes phase of lung injury partial volume observed in the acute or they may be due to with thickened

tous elements of inflammation indicate activity, reversibility, and favorable response to medical treatment, whereas a fibrotic component indicates to therapy. HRCT and irreversibility and poor response Nishimura et al. [83] correlated histopathologic findings in eight

averaging

:1

Fig. 20-69-year-old woman with clinical and radiographic signs of cardiogenic edema, both of which resolved with diuretic therapy. High-resolution CT scan shows interlobular sep tal thickening (large arrows), patchy areas of ground-glass opacity (small arrows), and right pleural effusion (open arrows).

Fig. 21-42-year-old-man with chronic progressive respiratory failure caused by idiopathic pulmonary fibrosis. High-resolution CT (HRCT) scan shows peripheral honeycombing and ground-glass opacity (660) bilaterally. 660 persisted on HRCT after treatment with steroids, consistent with fibrosis beyond resolution of CT scanner.

364

AJR:169,

August

1997

Ground-Glass

Opacity

at CT

Fig.22-46-year-old

woman with sarcoidosis and signs and symptoms of weight loss, shortness of breath, and cough. High-resolution CT scan shows bilateral areas of ground-glass opacity and airway dilatation radiating from hila to periphery of both lungs, with distribution along bronchovascular bundles. Right upper lobe transbronchial biopsy showed multiple noncaseating granulomas typical of sarcoidosis.

Fig. 23-34-year-old woman with sarcoidosis. CT scan shows of ground-glass opacity, correlating with histologic diagnosis

bilateral patchy of sarcoidosis.

areas

Fig. 24-25-year-old A and B, Conventional

asymptomatic man with sarcoidosis. (A) and high-resolution (B) CT scans

show patchy

bilateral

areas of ground-glass

opacity.

Underlying

reticular

pattern

is easier

to appreciate

on B.

patients

with

pulmonary

sarcoidosis.

The

most

lung
on

involvement
as 32% and GGO

in patients of patients
no correlation

with

sarcoidosis. of GGO
noted was

inflammatory
ing. and

or fibrotic
increased capillary

interstitial
blood

thickenvolume.

frequent ened small features

in the

CT

features

were

irregularly

thick-

As niany

had areas activity. infiltrates

bronchovascular nodules along corresponded

connective-tissue

bundles (88%) and vessels (50%). These to granulomas

sheath around

HRCT. patient

Numerous in to sole however,

processes correlating

can result finding the clinical of disease

in 000 history

as the with

between this granulomas

and population

disease could

000

or dominant

on chest

CT scans;

formed
the

correspond

and

inflammatory

or to

the CT distribution

and any associ-

pulmonary
present in

vessels
six patients

and with

airways.
(75%).

GGO
which

was corre-

mild fibrosis. HRCT findings pulmonary talcosis, a foreign tous reaction ing drugs. after have IV injection reported been

in three cases of body granulomaof talc-containby Padley et al.

ated CT findings can lead to the correct diagnosis or at least narrow the range of diagnostic possibilities. making
scans as easy

lated lesions,
fibrosis, and

histologically with
in the around

many and in lung

granulomatous alveolar specimens specimens Remy-Jarsepta of

Our classification a diagnosis

as the

scheme GGO
000

allows CT

or
small

without
vessels.

perigranulomatous
Active alveolitis

from
ABCs.

on chest

interstitium

[85]. In one of their cases, HRCT showed widespread GGO, thought to represent small granulomatous Conclusion 000
scans and is a nonspecific has been shown fmding on chest

For example. with sure clinical a temporal to inhaled symptoms allergic vascular

correlating history organic suggests alveolitis. history disease dusts

in a patient

could obtained

not be confirmed from areas

nodules.

of antigenic the diagnosis Systemic can strongly

expoof manisug-

any of the patients.

including showing

lung GGO.

and appropriate

din et al. [84] investigated the role of HRCT in determining disease activity and functional impairment and in predicting the prognosis of

CT
to

extrinsic festations collagen

histologically

or a known

of a particular

correlate

with

partial

filling

of

air

spaces.

AJR:169,

August

1997

365

Collins

and

Stern

gest

this

diagnosis

as

the

cause

of GGO.

and fibrosis.

honeycombing Features pulmonary are seen of

indicates barotrauma, emphysema,

pulmonary such and with as

18.

1 123-1 144 Nhieu JTV, Vojtek AM, Bernaudin alveolar carinii: lavage JE Escudier E, asso-

000 may scans in symptoms ILD). patient nary-renal

be the predominant finding on CT cigarette smokers with clinical of interstitial lung disease (RBis a consideration history who has multifocal in a or a known syndrome of a pulmo-

interstitial mothorax, matoceles although population

pneupneuARDS,

Fleury-Feith ciated
with identification

J. Pulmonary

proteinosis

pneumomediastinum, in patients CT finding the initial

Pizeunzocvsus
in bronchoalveolar

ultrastructural in AIDS

and
CheSt

Hemorrhage with

immunocompromised 1990:98:801-805

non-AIDS

patients.

in this patient

may be GGO

and consolidation.

19. Godwin alveolar

169:609-613 20. Murch appearances

JD,

MUller

NL, Takasugi
CT DH. findings. Computed alveolar

JE. Pulmonary
Radiology 1988;

diffuse areas of OGO on CT. In a patient with sickle cell disease and an acute onset of fever and areas diffuse alveolar mia, P. acute nosuppressed chest pain, diagnosis of 000. GGO acute chest syndrome is the shows diffuse probable when A pattern on CT scans the CT scan suggests References
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