Attenuation ground-glass

A chest X-ray showed diffuse interstitial and alveolar infiltrates and small bilateral pleural effusions. A high-resolution CT scan of the chest showed diffuse ground-glass attenuation and patchy peripheral opacities, consistent with an acute hypersensitivity pneumonitis, and other diagnoses were ruled out. He responded to gluco-corticoids. 

HRCT is characterized by bilateral, symmetrical, geometric areas of ground-glass attenuation (Fig. 26.20). The interlobular septa are thickened, and a fine network of interlobular lines can be seen. These changes... 

Remy-Jardin M, Giraud F, Remy J, et al. Importance of ground-glass attenuation in chronic diffuse infiltrative lung disease pathologic-CT correlation. Radiology 1993 189(3) 693-698. 

Muller NL, Miller RR. Ground-glass attenuation, nodules, alveohtis, and sarcoid granulomas. Radiology 1993 189(l) 31-32. 

Figure 1 (A) Anteroposterior chest radiograph of a 33-year-old patient with subacute HP showing diffuse ground-glass attenuation. (B) Bird-related chronic HP. Chest radiograph shows shortening of the lung fields, diffuse reticulonodular opacities, and signs of pulmonary arterial hypertension. Abbreviation HP, hypersensitivity pneumonitis.

Chest radiography wiU usually reveal parenchymal infiltrates, and lung volume appears reduced unless there is coexisting obstructive airway disease (8,10,17). The chest radiographic appearance is nonspecific and consists of patchy ground-glass attenuation with a lower zone predominance or nonspecific reticular or reticulonodular pattern (8,10,17). The chest radiograph may look normal in up to 20% of DIP cases (8,10,17). 

Multicentric Castleman disease usually demonstrates extensive lymph node involvement, in contrast to the solitary involvment with unicentric Castleman disease. In addition, pulmonary parenchymal abnormalities such as thin-walled cysts, thickening of the bronchovascular bundles, and interlobular septal thickening, subpleural nodules, ground-glass attenuation, air-space consolidation, and bronchiectasis can be seen (25). 

HRCT features, reported in numerous studies (53,95,96,100-104), appear to be homogeneous, reflecting the high prevalence of a pure NSIP pattern (Fig. 2A,B) (100), compared with other CTDs. HRCT abnormalities include ground-glass attenuation (74—100%) and linear opacities (74—90%), alone or with traction bronchiectasis or bronchiolectasis (68-76%), consolidation (33%), and honeycombing (30-40%). Early disease is predominantly peripheral and posterior at... 

The most frequent signs on HRCT are reticular opacities (15-98%), ground-glass attenuation (2-90%), honeycombing (6-71%), and consolidation (3-35%)... 

In HRCT studies of PM/DM-ILD, ground-glass attenuation is the most frequent sign (48-100%), alone, or admixed with reticular opacities (50-83%). Other feamres include subpleural or peri-bronchovascular consolidation (40-100%), traction bronchiectasis or bronchiolectasis (14.8-67%), and honeycombing... 

There is a paucity of histological data, based on the ATS/ERS classification of IIPs, with NSIP reported in a handful of cases (4). Early signs on HRCT in early include areas of ground-glass attenuation, alone (78%) or in association with mild reticular abnormalities (22%) (Fig. 15) (324,325). In later disease, honeycombing is exceedingly rare, even when fibrosis is extensive (324-326). The distribution on HRCT is predominantly basal, peripheral, and posterior. 

Figure 16 HRCT appearances in a patient with scleromyositis, showing prominent organizing pneumonia, associated with ground-glass attenuation (indicative of underlying nonspecific interstitial pneumonia).

Fig. 3.1.2a,b. Thin-section computed tomography images obtained supine a and prone b in a 73-year-old worker exposed to asbestos. A fine reticular pattern (arrows) and increased ground glass attenuation are seen on the supine image, predominantly in the dependent areas. These features persist on the prone images and are in keeping with early asbestosis... 

Fig. 12.2a,b. Aluminum pneumoconiosis, (a) Fine striations, nodular, and ground-glass opacities more pronounced in the upper and middle lung zones and displacement of the hila upwards are seen, (b) Thin-section computed tomography scan of the same patient shows areas of ground-glass attenuation around the bronchovascular bundles and traction bronchiectasis... 

Thin-section CT in patients who are exposed to chlorine gas demonstrates diffuse centrilobular nodular areas of ground-glass attenuation and/or patchy areas of ground-glass attenuation (Fig. 12.12) (Akira 2002). 

Fig. 13.1 la,b. Hypersensitivity pneumonitis with the patholog- Fig. 13.13. Subacute phase. Diffuse ground-glass attenuation ical characteristics of non-specific interstitial pneumonitis nodules...

In the centrilobular pattern, the pleural and fissural surfaces are spared (Fig. 13.12). The nodules of ground-glass attenuation are diffuse (Fig. 13.13), and impacted airways are absent. There is a relationship between the nodules and the visible arterial branches, which are themselves centrilobular structures. Centrilobular nodules maybe observed in HP... 

Fig. 6.2.2. A 36-year-old female patient with Pneumocystis pneumonia (PCP) after allogeneic hematopoietic stem cell transplantation. HRCT scan at the level of the lower lohes demonstrates diffuse bilateral patchy areas of ground-glass attenuation...

Fig. 6.2.3. Halo sign due to angioinvasive aspergillosis in a 47-year-old woman after allogeneic hematopoietic stem cell transplantation. Close-up view of a HRCT scan at the right lower lohe shows a peripheral nodular opacity with a surrounding halo of ground-glass attenuation. These findings correspond to a nodular area of infarction surrounded by hemorrhage...

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