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. 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. It is entirely possible to have these lesions for many years. When a substance other than air fills an area of the lung it increases that area's density. 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. 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. [17][19] This is in contrast to the two similar coronaviruses, SARS and MERS, which more commonly involve only one lung on initial imaging. 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. It was published as part of a glossary of recommended nomenclature from the Fleischner Society, a group of thoracic imaging radiologists. (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. So, if you see ground glass opacity on your lung scans, it indicates that you are experiencing some form of respiratory distress. 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. [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. Pneumocystis pneumonia, an infection typically seen in immunocompromised (e.g. Hazy regions of opacity are noted in the parahilar lung in this patient with acute pulmonary hemorrhage due to Wegener’s granulomatosis. 6. Most commonly, initial CT imaging reveals bilateral GGOs at the periphery of the lungs. Ground-glass opacity (GGO) is a finding seen on chest x-ray (radiograph) or computed tomography (CT) imaging of the lungs. AJR Am J Roentgenol. [6] COVID-19 has also been shown to occasionally cause GGOs with a crazy paving pattern. [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. Pleural effusion is the appearance of fluid in the layer between the lungs and chest wall. [11] In addition, AAH often lacks the solid features and spiculated appearance that are often associated with malignant growths. 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… A diffuse haziness would typically be caused by inflammation or thickening of tissues and there's a variety of different causes and patterns. 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). Radiographics. Potential causes of centrilobular GGOs include pulmonary calcifications from metastatic disease, some types of idiopathic interstitial pneumonias, hypersensitivity pneumonitis, aspiration pneumonitis, cholesterol granulomas, and pulmonary capillary hemangiomastosis. 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. A correlation of imaging with a patient's clinical features is useful in narrowing the diagnosis. Koo HJ, Lim S, Choe J et-al. [10][11], Centrilobular GGOs refer to opacities occurring within one or multiple secondary lobules of the lung, which consist of a respiratory bronchiole, small pulmonary artery, and the surrounding tissue. X-ray finding: "ground glass" is a way of describing the appearance of the lungs in certain pathological states. 27 (3): 595-615. Radiology. When air is replaced by another substance (e.g fluid or fibrosis), the density of the area increases, causing the tissue to appear lighter or more grey. [4], Ground-glass opacity is most often used to describe findings in high-resolution CT imaging of the thorax, although it is also used when describing chest radiographs. The findings of ground glass opacity are seen in many lung conditions and need to be correlated with your clinical findings. Benign conditions potentially leading to the formation of nodular GGOs include aspergillosis, acute eosinophilic pneumonia, focal interstitial fibrosis, granulomatosis with polyangiitis, IgA vasculitis, organizing pneumonia, pulmonary contusion, pulmonary cryptococcus, and thoracic endometriosis. [6], A mosaic pattern of GGO refers to multiple irregular areas of both increased attenuation and decreased attenuation on CT. 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. 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. 4. Ground glass opacifications (GGO) are a subset of pulmonary nodules or masses with non-uniformity and less density than solid nodules. It can be, and often is, a precusor to lung cancer. Radiographics. These patients may develop lung "white-out" with progression to acute respiratory distress syndrome (ARDS) requiring treatment escalation. This is a most commonly seen in various types of pulmonary infections, including CMV pneumonia, tuberculosis, nocardia infection, some fungal pneumonias, and septic emboli. Schistosomiasis, a parasitic infection, also commonly presents with the halo sign. Please do not worry. [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]. 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. CT image showing crazy paving pattern of ground-glass opacities in both lungs. Several studies have described a pattern among initial, intermediate, and hospital discharge imaging findings in the disease course of COVID-19. 3. 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. 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