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Ground-glass opacification

Dr Tim Luijkx ◉ ◈ and Dr Behrang Amini et al.

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.

On this page:

Article:

Pathology
Differential diagnosis
See also
References

Images:

Cases and figures

Pathology

Etiology

Ground-glass opacities have a broad etiology:

normal expiration
partial filling of air spaces
partial collapse of alveoli
interstitial thickening
inflammation
edema
fibrosis
lepidic proliferation of neoplasm

Morphological forms

Differential diagnosis

Broadly speaking, the differential for ground-glass opacification can be split into ⁵:

infectious processes (usually opportunistic)
chronic interstitial diseases
acute alveolar diseases
other causes

Opportunistic infections

pneumocystis pneumonia (PCP/PJP)
cytomegalovirus pneumonia (CMV)
herpes simplex virus pneumonia (HSV)
respiratory syncytial virus bronchiolitis (RSV): type of infectious bronchiolitis
other infectious causes

Chronic interstitial diseases

eosinophilic pneumonias: GGO can be seen in many of the eosinophilic pneumonias but is most commonly seen in ²
- 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 ³
- 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
- cardiogenic pulmonary edema
- adult respiratory distress syndrome (ARDS)
- other causes of non-cardiogenic 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 bronchioalveolar 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; may 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

See also

References

Article information

rID: 1404

System: Chest

Section: Approach, Gamuts

Tag: infectiousdisease

Synonyms or Alternate Spellings:

Ground glass opacification
Ground glass changes
Differential of ground glass opacity
Differential of ground glass opacities
Differential of ground-glass opacity
Differential of ground-glass opacities
Ground-glass changes
Ground glass opacities (GGO)
Ground glass
Ground-glass attenuation
Ground-glass
Ground glass densities
Ground glass density
Ground glass attenuation
Ground glass attenuation regions
Groundglass attenuation regions
Ground glass attenuating regions
Ground-glass opacity
Ground-glass opacification/opacity (GGO)
Ground glass opacity
GGOs

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Cases and figures

Case 1: amiodarone lung Case 1: amiodarone lung

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Case 2: angioinvasive aspergillosisCase 2: angioinvasive aspergillosis

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Case 3: sarcoidosisCase 3: sarcoidosis

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Case 4: COPCase 4: COP

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