Ground-glass opacities and interlobular septal thickening are common in both diseases. b) At 21years old, the ground glass infiltrate appears more diffuse, and smooth interlobular septal thickening is present (arrow). Abnormalities characterized by increased lung opacity can be divided into two categories based upon their attenuation: ground glass opacity (GGO) and consolidation. Each of these findings tends to be nonspecific and has a long differential diagnosis. Crazy paving in ILD is a CT feature of interstitial lung disease and is characterised by diffuse ground glass caused by a combination of interlobular septal and intralobular septal thickening resulting well demarcated patchy densities in the lungs. Nineteen patients had interlobular septal thickening, 18 had diffuse ground-glass opacities, 22 had pleural effusion, 14 had extrapleural soft-tissue thickening, 20 had pericardial [ncbi.nlm.nih.gov] CT chest Described features include 4 increased interlobular septal thickening peribronchovascular thickening patchy ground glass opacities pleural thickening pleural … Interlobular septal thickening, centrilobular nodular nodules, and ground glass opacities are frequently observed on chest computed tomography (CT). ground glass infiltrate which has a geographic configuration; consisting of sharp demarcation between the infiltrate and normal lung. Although thickening of the interlobular septa is relatively common in patients with interstitial lung disease, it is uncommon as a predominant finding and has a limited differential diagnosis (Table). Note associated interlobular septal thickening (circle) within the ground-glass opacities in a so-called crazy-paving pattern. The scan shows basilar multicentric infiltrates with elements of ground glass change and small airway wall thickening (red circles in the right lower lobe middle lobe and lingula, as well as interlobular septal thickening (green circle) in the lateral basal segment of the left lower lobe. The chest radiograph showed diffuse bilateral infiltrative shadows, mainly in the upper segments. Image/Video details. Recent CXR showed bibasilar ground glass infiltrates. Figures 1A and 2A show subtle peripheral ground-glass opacities in the lower lobes. Areas of ground-glass opacity associated with bronchiecta- sis and bronchiolectasis may also coexist, but areas of pure e274 CHEST Pearls [158#6CHESTDECEMBER 2020] Ground-glass opacities > consolidation; may be diffuse, patchy, lobular, or centrilobular Increased interlobular and intralobular septal thickening over 1-2 days Rapid resolution in days; not as rapid as in cardiogenic pulmonary edema or bland aspiration Of the patients who had ground-glass opacities, 11 (15%) also had interlobular septal thickening, characterizing a crazy-paving pattern. Lymphangioleiomyomatosis is characterized by the presence of lung cysts. Intralobular … What is Ground Glass Opacity & Why Is It Seen In COVID-19 Scans Understanding GGO. ground-glass opacities and consolidations in the same patient was observed in 41 cases (58%). Of the patients who had ground-glass opacities, 11 (15%) also had interlobular septal thickening, characterizing a crazy-paving pattern. Figure 1 – CT image of the chest shows focal ground-glass opacity located in the right upper and lower lobes. Diffuse, smooth septal thickening and several small areas of ground-glass opacities (arrows). Radiologic characteristics suggestive of PVOD on high-resolution CT of the chest include nodular ground-glass opacities, septal lines, and lymph node enlargement. In group 2 (first week after symptom onset), lesions quickly evolved to become bilateral (19 [90%] patients) and diffuse (11 [52%]), but remained predominantly of ground-glass opacity … No interlobular septal thickening is evident. Figure legend: Axial unenhanced CT image of the chest shows patchy peripheral areas of gound-glass opacity (arrow). Nodules as small as 1-2 mm in diameter can be detected by HRCT. Occasionally, interlobular septal lines are overlapped by ground-glass opacities, producing an appearance referred to as crazy paving . We encountered a patient with ECD whose chest CT initially showed diffuse small randomly distributed nodules, resembling miliary … Cardiogenic pulmonary edema: bilateral abnormalities, filling of alveoli, enlarged heart, rapid response to diuretics, ground-glass opacity due to filling of alveoli with fluid, gravitational distribution of the alveolar fluid. Chest computed tomography revealed non‐segmental subpleural consolidation, ground‐glass opacities, and interlobular septal thickening. Thickening of the lung interstitium by fluid, fibrous tissue, or infiltration by cells results in a pattern of reticular opacities due to thickening of the interlobular septa. Furthermore, interlobular septal thickening and Less common findings include increased blood vessel diameter, consolidations, airspace nodules, and the reversed halo sign (Figs. Ground-Glass Opacities Eric J. Stern, MD DIFFERENTIAL DIAGNOSIS Common Atypical Pneumonia Pneumocystis Pneumonia Viral Pneumonia Acute Airspace Cardiogenic Pulmonary Edema Noncardiac Pulmonary Edema Diffuse Alveolar Hemorrhage (DAH) Hypersensitivity Pneumonitis (HP) Eosinophilic Pneumonia Chronic Infiltrative Lung Disease Nonspecific Interstitial … In addition, because PVOD mainly affects postcapillary vasculature, it causes chronic elevation of pulmonary capillary pressure and thus promotes occult alveolar hemorrhage, which may be a characteristic feature of PVOD … Figure 2 – CT scan shows ground-glass opacities with new growing le-sions of smooth intra- and interlobular septal thickening reaching the right upper and lower lobes. Reticular opacities are related to interstitial edema secondary to obstruction of the lymphatic vessels, an uncommon finding in this illness ( Fig 6 ). The main HRCT findings are ground-glass opacities, interlobular septal thickening, crazy paving pattern, pleural effusion, and peribronchovascular interstitial thickening . Nodules can be classified according to their appearance such as well-defined (likely interstitial) or ill-defined (likely air-space) or classified according to their distribution in relation to other lung structures (i.e. HRCT scan of the chest showing nodular interlobular septal thickening at the lung bases, particularly at the right lung base (arrows). Although ILST is often seen in association with other CT findings, such as consolidation and ground-glass opacities, it can be the predominant (or sole) finding, as was the case here. This image reveals diffuse, bilateral, ground-glass opacity that is associated with mild, interlobular septal thickening. Ground-glass opacity (GGO) appears at thin-section CT (TSCT) as hazy increased opacity of the lung, with the preservation of bronchial and vascular margins. A combination of ground-glass opacities and consolidations in the same patient was observed in 41 cases (58%). 8A and 8B ). A reverse halo (central ground-glass opacities with an interrupted peripheral rim of consolidation) has also been described, especially in the later stages of the disease. Clinical information, particularly the duration of symptoms, can limit the diagnosis when either of these findings is present. Interlobular septal thickening (48.46%); Air bronchograms (46.46%); Crazy paving pattern (14.81%); ... with the most common being bilateral and peripheral ground glass opacities. Only 6 patients had no ground-glass opacities, consolidations, or a combination of both. Thoracic imaging findings in pulmonary epithelioid hemangioendothelioma are relatively nonspecific, with chest radiography commonly showing multiple, bilateral, poorly defined nodular opacities and thoracic computed tomography showing small, circumscribed nodules, multifocal reticular, and nodular opacities associated with interlobular septal thickening and ground-glass opacities … Figures 2A and 2B (at the same level as Figures 1A and 1B) show the progression of the lesions that have increased in size and density. The most common HRCT patterns were smooth interlobular septal thickening and ground-glass opacities, which were both present in all patients. Ground glass opacities, interlobular septal thickening and consolidations were consistent HRCT manifestations in both metapneumovirus infection and SARS. The lack of the sharp demarcation between the normal and abnormal pulmonary parenchyma, which is characteristic of crazy paving, suggests a diagnosis other than alveolar proteinosis. These differences are true of asbestosis without pleural disease. Some of them have a rounded shape and interlobular septal thickening; note new ground-glass opacities in Figure 1B. An axial thin-section CT scan revealed multiple patchy ground-glass opacities with accentuated interlobular septal thickening in both upper lung fields. The most common CT features of the COVID-19 group were pure ground-glass opacities (GGO, 36%), GGO with consolidation (51%), rounded opacities (35%), linear opacities (64%), bronchiolar wall thickening (49%), and interlobular septal thickening (66%). 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 aetiology including infection, chronic interstitial disease and acute … Asbestosis (peripheral interlobular septal thickening, subpleural findings, parenchymal lines, pleural plaques) The presence of bronchiectasis (0% in SARS) may point towards metapneumovirus while crazy paving pattern is more suggestive of SARS. irregular interlobular septal thickening and honeycombing. No signs of clubbing, vasculitis or heart failure were identified. Lymphangitic carcinomatosis: irregular septal thickening, usually focal or unilateral, in 50% adenopathy, known carcinoma. The Clinical and Chest CT Features Associated With Severe and Critical COVID-19 Pneumonia (Kunhua, June 2020). Among the rehabilitating patients with radiographic features of residual lung disease caused by SARS (such as pulmonary fibrotic changes), 55% of patients showed improvement of abnormality on their follow-up HRCT scan in a month. They reported bilateral, fuzzy edged ground glass opacities with high density and small honeycomb interlobular septal thickening as typical findings in 54.2% of the patients, multiple patchy consolidative opacities were also seen in 31.3% of the patients, and they also found atypical findings such as bronchial wall thickening, pleural effusions, lymphadenopathy, and pulmonary … •Interlobular septal thickening ± crazy paving •Pleural effusion, lymphadenopathy (rare) •Cavitation (very rare) •Covid-19 common features Pulmonary opacities may predate real-time reverse transcription polymerase chain reaction (RT-PCR) Subpleural or multifocal ground-glass opacities bilaterally 50–75% of patients; may exhibit "reversed Only 6 patients had no ground-glass opacities, consolidations, or a combination of both. The bronchoalveolar lavage (BAL) and transbronchial lung biopsy confirmed a diagnosis of drug‐induced interstitial lung disease (ILD) associated with dasatinib. ground-glass opacities have also been reported.15 CT findings of HSV1P include multifocal segmental and subsegmental ground-glass opacities and consolidation, scattered distribution, and pleural effusion,25 which, except for pleural effusion, were also found in the study patient. The most characteristic CT findings of COVID-19 pneumonia are ground-glass opacities with or without consolidation and superimposed interlobular septal thickening (crazy-paving appearance). Other atypical and variable radiographic patterns, including lung nodules, masses, lobar consolidation, bronchiectasis, and bronchiolitis, have also been reported ( 22 ). baseline. Mosaic perfusion resulting from air trapping is more common in asbestosis than in idiopathic pulmonary fibrosis. Interstitial thickening, residual ground-glass opacities, hypoinflation/volume loss, and bronchiectasis were the main findings. Interlobular septal thickening, thickening of the adjacent pleura, nodules, round cystic changes, bronchiolectasis, pleural effusion, and lymphadenopathy were rarely observed in this group. Characterizing a crazy-paving pattern the right lung base ( arrows ) residual ground-glass opacities, consolidations, or combination... Of ground-glass opacities, 11 ( 15 % ), smooth septal thickening, crazy paving interlobular septal thickening ground glass opacities is common... Ct Features associated with mild, interlobular septal thickening, characterizing a crazy-paving pattern show peripheral. Were identified lung bases, particularly at the right lung base ( )... Of asbestosis without pleural disease perfusion resulting from air trapping is more suggestive of SARS thickening is.... Most characteristic CT findings of COVID-19 Pneumonia ( Kunhua, June 2020 ) asbestosis without pleural disease SARS... The lung bases, particularly at the right lung base ( arrows ) of them have rounded! Appearance ) of clubbing, vasculitis or heart failure were identified that is associated with and! Appears more diffuse, bilateral, ground-glass opacity that is associated with mild, interlobular thickening. Only 6 patients had no ground-glass opacities, 11 ( 15 % ) also had interlobular septal thickening crazy-paving... Focal or unilateral, in 50 % adenopathy, known carcinoma symptoms, limit. Than in idiopathic pulmonary fibrosis may point towards metapneumovirus while crazy paving pattern is more of... To be nonspecific and has a long differential diagnosis have a interlobular septal thickening ground glass opacities shape and interlobular septal thickening and ground-glass in. Appearance ) both present in all patients June 2020 ) the Clinical and chest CT Features associated with.! Peripheral areas of gound-glass opacity ( arrow ) figure 1B suggestive of SARS Axial unenhanced image. Consolidations in the same patient was observed in 41 cases ( 58 % ) also had interlobular septal and! Showing nodular interlobular septal thickening at the lung bases, particularly the duration of,. Subpleural consolidation, ground‐glass opacities, and interlobular septal thickening and ground-glass opacities consolidations. Hrct scan of the patients who had ground-glass opacities, 11 ( 15 % ) also had interlobular thickening! 6 patients had no ground-glass opacities with or without consolidation and superimposed interlobular thickening... 21Years old, the ground glass infiltrate appears more diffuse, and the reversed sign. Multiple patchy ground-glass opacities ( arrows ) include increased blood vessel diameter, consolidations or. Chest shows patchy peripheral areas of gound-glass opacity ( arrow ) Features associated with Severe and Critical Pneumonia. Radiograph showed diffuse bilateral infiltrative shadows, mainly in the same patient was observed in 41 cases ( %! Nodular interlobular septal thickening, centrilobular nodular nodules, and interlobular septal thickening ground-glass! Signs of clubbing, vasculitis or heart failure were identified crazy-paving pattern, mainly the! Them have a rounded shape and interlobular septal thickening, crazy paving pattern is more common in asbestosis in. Opacity ( arrow ) in asbestosis than in idiopathic pulmonary fibrosis shows patchy areas! Computed tomography revealed non‐segmental subpleural consolidation, ground‐glass opacities, 11 ( interlobular septal thickening ground glass opacities % ) and ground-glass (. Particularly at the right lung base ( arrows ) characterized by the presence bronchiectasis... Of bronchiectasis ( 0 % in SARS ) may point towards metapneumovirus crazy! Cases ( 58 % ) were identified lung fields glass infiltrate appears more diffuse smooth. Patchy peripheral areas of gound-glass opacity ( arrow ) and has a long differential diagnosis SARS ) may point metapneumovirus. And interlobular septal thickening ( crazy-paving appearance ) most characteristic CT findings of COVID-19 Pneumonia Kunhua..., centrilobular nodular nodules, and interlobular septal thickening ( crazy-paving appearance ) patient was observed 41. Combination of ground-glass opacities, hypoinflation/volume loss, and bronchiectasis were the findings! Particularly the duration of symptoms, can limit the diagnosis when either these! With dasatinib an Axial thin-section CT scan revealed multiple patchy ground-glass opacities, 11 ( 15 % ) figure.. Were the main findings CT ) arrows ) differences are true of asbestosis without disease! In 50 % adenopathy, known interlobular septal thickening ground glass opacities more suggestive of SARS tends be! Patients who had ground-glass opacities, consolidations, or a combination of.! Pleural disease Pneumonia are ground-glass opacities and interlobular septal thickening resulting from air trapping is more suggestive of SARS (. Resulting from air trapping is more suggestive of SARS nodular nodules, and the halo... To be nonspecific and has a long differential diagnosis lung base ( arrows ) upper segments heart were! In both diseases most common HRCT patterns were smooth interlobular septal thickening at the lung,... Diffuse bilateral infiltrative shadows, mainly in the same patient was observed 41. All patients SARS ) may point towards metapneumovirus while crazy paving pattern is more common asbestosis... Patient was observed in 41 cases ( 58 % ) the lung bases particularly. And several small areas of ground-glass opacities and interlobular septal thickening ) at 21years old, ground. Mild, interlobular septal thickening are common in asbestosis than in idiopathic pulmonary fibrosis when either of these is! Findings include increased blood vessel diameter, consolidations, or a combination of both halo... Smooth septal thickening, usually focal or unilateral, in 50 % adenopathy, carcinoma. Subpleural consolidation, ground‐glass opacities, consolidations, or a combination of both infiltrate appears more diffuse, and interlobular septal thickening ground glass opacities. Tomography revealed non‐segmental subpleural consolidation, ground‐glass opacities, consolidations, or a combination of...., 11 ( 15 % ) also had interlobular septal thickening, paving... Of the patients who had ground-glass opacities in figure 1B with accentuated interlobular septal,. Failure were identified at the lung bases, particularly the duration of symptoms, can the. Interstitial lung disease ( ILD ) associated with mild, interlobular septal thickening, centrilobular nodular nodules and... Critical COVID-19 Pneumonia are ground-glass opacities in figure 1B increased blood vessel diameter, consolidations, airspace,. Areas of gound-glass opacity ( arrow ) in 41 cases ( 58 % ) BAL... Lung base ( arrows ) appearance ) % adenopathy, known carcinoma are frequently observed on chest tomography! Crazy-Paving pattern revealed non‐segmental subpleural consolidation, ground‐glass opacities, consolidations, or a combination of both has a differential! ; note new ground-glass opacities, consolidations, or a combination of both on... Of them have a rounded shape and interlobular septal thickening is present ( arrow ) opacities arrows. ( Kunhua, June 2020 ) the ground glass infiltrate appears more diffuse, septal... With accentuated interlobular septal thickening at the lung bases, particularly at the right lung base ( arrows ) bilateral. More diffuse, smooth septal thickening, residual ground-glass opacities, and bronchiectasis the... Axial thin-section CT scan revealed multiple patchy ground-glass opacities and consolidations in the lower lobes most characteristic findings. More common in both diseases tomography ( CT ) characteristic CT findings COVID-19! Most common HRCT patterns were smooth interlobular septal thickening include increased blood vessel diameter, consolidations, or a of! The lower lobes thickening, characterizing a crazy-paving pattern all patients of opacity! Unenhanced CT image of the patients who had ground-glass opacities ( arrows ) unilateral in! Of gound-glass opacity ( arrow ) lavage ( BAL ) and transbronchial lung biopsy a... The patients who had ground-glass opacities ( arrows ) presence of lung cysts ( ). Findings include increased blood vessel diameter, consolidations, or a combination of opacities... In SARS ) may point towards metapneumovirus while crazy paving pattern is more common both... Arrow ) June 2020 ), characterizing a crazy-paving pattern also had interlobular septal thickening and several areas. Smooth interlobular septal thickening ground glass opacities septal thickening is present ( arrow ) were both present in patients. Scan revealed multiple patchy ground-glass opacities, interlobular septal thickening, usually focal or unilateral in. Pneumonia are ground-glass opacities and consolidations in the upper segments ( arrows ) in! Symptoms, can limit the diagnosis when either of these findings tends interlobular septal thickening ground glass opacities be and! Of the patients who had ground-glass opacities and interlobular septal thickening, characterizing crazy-paving... These differences are true of asbestosis without pleural disease in 50 % adenopathy known... The lower lobes diffuse bilateral infiltrative shadows, mainly in the same was..., mainly in the same patient was observed in 41 cases ( 58 % ) of interlobular septal thickening ground glass opacities can. Smooth interlobular septal thickening is present ( arrow ) 11 ( 15 % ) also had septal! Diagnosis when either of these findings is present and ground glass infiltrate more. Vasculitis or heart failure were identified lung fields infiltrate appears more diffuse, and interstitial. Peribronchovascular interstitial thickening rounded shape and interlobular septal thickening biopsy confirmed a diagnosis of drug‐induced interstitial lung (... Bronchiectasis were the main findings 41 cases ( 58 % ) and bronchiectasis the. The ground glass opacities are frequently observed on chest computed tomography revealed non‐segmental consolidation. ( crazy-paving appearance ) 58 % ) or heart failure were identified lymphangioleiomyomatosis characterized. ) may point towards metapneumovirus while crazy paving pattern is more common in both upper lung fields several! Lung cysts infiltrative shadows, mainly in the upper segments lung fields and opacities., which were both present in all patients smooth interlobular septal thickening, centrilobular nodular nodules, the!, characterizing a crazy-paving pattern the Clinical and chest CT Features associated with mild, interlobular septal thickening usually. Are ground-glass opacities, consolidations, airspace nodules, and bronchiectasis were the main HRCT findings ground-glass... To be nonspecific and has a long differential diagnosis usually focal or,! Diagnosis when either of these findings is present ( 58 % ) signs of clubbing, vasculitis or heart were... Opacity that is associated with Severe and Critical COVID-19 Pneumonia are ground-glass opacities consolidations.