Isolated Diffuse Ground-Glass Opacity in Thoracic CT: Causes and Clinical Presentations

Miller, Wallace T.; Shah, Rosita M.

doi:10.2214/ajr.184.2.01840613

Cited by 88 publications

(48 citation statements)

References 86 publications

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“…The presence of B-lines and white lung in pulmonary areas of a CT ground glass pattern is in line with this hypothesis, if we consider the nature and the definition of ‘preconsolidating' densities seen on CT named ground glass [28]. According to the results obtained, we are able to support the fact that a preconsolidating state of the cortical lung does not allow the ultrasound beam (in the frequency range of a commercial 9-MHz probe) to penetrate the whole tissue volume to build clear anatomic pictures (as in pneumonia), and also not be specularly reflected producing A-lines (as in normal lung).…”

Section: Discussionmentioning

confidence: 71%

Lung Ultrasonography May Provide an Indirect Estimation of Lung Porosity and Airspace Geometry

Soldati¹,

Smargiassi

Inchingolo

et al. 2014

Respiration

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Background: Echographic vertical artifacts (B-lines) in chest ultrasonography have often been associated with pathological patterns. A scientifically sound explanation of these artifacts has not yet been proposed. Objectives: The ‘spongy' nature of the lung in its liquid and solid components and the changes that take place in peripheral airspace (PAS) geometry might be the key point to understanding these phenomena. Methods: Six excised right rabbit lungs were obtained. Each lung underwent direct ultrasound evaluation in two different conditions: at complete tissue elastic recoil volume and at pulmonary expansion volume achieved by applying a constant positive pressure of 12 cm H₂O. Lung volumes and densities were reported in both conditions. Histological examination was performed on three naturally collapsed lungs and on three lungs under positive pressure inflation after having been fixed in formalin solution. Results: Mean volumes of naturally collapsed lungs and fixed expanded lungs were 11.2 ± 0.36 and 44.83 ± 3.03 ml, respectively. Mean densities were 0.622 ± 0.016 and 0.155 ± 0.007 g/ml, respectively. Ultrasound evaluation of collapsed lungs showed dense vertical artifacts and a ‘white lung' pattern, while the evaluation of expanded lungs showed hyperechoic line and horizontal artifacts of reflection. Histological evaluation showed a different PAS geometry in collapsed lungs caused by alveolar size reduction and shape changes with unfolded and closed units modifying the peripheral porosity of the frothy nature of the lung. Conclusions: Airspace geometry, frothy nature and porosity are the determinants of the different behavior of ultrasound interacting with the subpleural lung parenchyma. Chest ultrasound may thus be interpreted as an indirect ‘estimator' of lung porosity.

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Section: Discussionmentioning

confidence: 71%

Lung Ultrasonography May Provide an Indirect Estimation of Lung Porosity and Airspace Geometry

Soldati¹,

Smargiassi

Inchingolo

et al. 2014

Respiration

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“…The entity of this relationship is at the base of the generation of ring-down artifacts as well as radiologic ground glass opacities. 38 This mechanism takes place in all cases in which alveoli are "bathed" by either transudates or exudates (eg, hyaline membrane disease, alveolar proteinosis, and general inflammation). We experimentally verified that single air bubbles and linear millimetric bubbles (1-dimensional cluster) scanned with frequencies of 3.5 to 10 MHz do not produce ULCs but in certain cases only short comet tail reverberations.…”

Section: Discussionmentioning

confidence: 99%

Sonographic Interstitial Syndrome

Soldati¹,

Copetti

Sher

2009

Journal of Ultrasound in Medicine

225

172

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Objective. Ultrasound lung comets (ULCs) now have an acknowledged correlation with extravascular lung water, but they present in different orders and numbers in different pathologic pulmonary entities. How these artifacts are created is not yet known, and the literature gives discordant hypotheses. Understanding their formation is the first step in understanding lung disease. The purpose of this study was to show the morphologic and genetic variability of interstitial lung disease studied with echography and thus to propose a unitary mechanism for the formation of ULCs. Methods. This study included 3 parts: (1) a retrospective analysis of echographic lung images of patients with interstitial syndrome; (2) an analysis of the literature for definitions of the size of the pulmonary lobule; and (3) an experimental model of different air-water interfaces scanned with varying ultrasonic frequencies.Results. The retrospective analysis of echographic lung images included 176 patients with diffuse ULCs: 118 patients had acute pulmonary edema; 18 had acute lung injury/acute respiratory distress syndrome; and 40 were premature neonates with respiratory distress syndrome. Experimental models permitted us to discover that ring-down artifacts are produced only by single and double layers of bubbles in specific structural settings. Conclusions. Reverberation between bubbles with a critical radius seems to be at the origin of ring-down artifacts. Echographic manifestations of interstitial lung disease, whose genesis lies in the partial air loss of lobes and segments, are acoustic phenomena originating from variations in the tissue-fluid relationship of the lung. A correlation between anatomopathologic characteristics and structures of sonographic artifacts could allow more rapid and noninvasive diagnoses.

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“…(84) In HP, groundglass opacity indicates subacute disease. With relevant exposure, a ground-glass opacity pattern associated with centrilobular nodules and lobular air trapping (the so called "head-cheese pattern" or "terrine sign", Figure 18) is highly suggestive of the diagnosis.…”

Section: Hypersensitivity Pneumonitismentioning

confidence: 99%

“…(84) Rare patients will present some of the atypical causes of chronic consolidation/ground-glass opacity, such as pulmonary alveolar proteinosis (PAP), bronchoalveolar carcinoma (BAC), and lymphoma. Although ground-glass opacity and consolidation can denote interstitial or alveolar disease, (85) ground-glass opacity is more often seen in HP, DIP, RB-ILD, and NSIP.…”

Section: Chronic Consolidation/ground-glass Opacitiesmentioning

confidence: 99%

Padrões tomográficos das doenças intersticiais pulmonares difusas com correlação clínica e patológica

et al. 2008

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High-resolution computed tomography (HRCT) is the radiological imaging technique best suited to revealing changes in lung structure. Various HRCT findings, taken together, can represent typical patterns. These patterns, in conjunction with the anatomical distribution of findings and with clinical data, can narrow the differential diagnosis of diffuse interstitial lung disease and, in many cases, indicate the correct diagnosis with a high degree of accuracy. The most common HRCT patterns seen in cases of diffuse interstitial lung diseases are the nodular pattern, linear/reticular opacities, cystic lesions, ground-glass opacities and consolidations. This article reviews the correlations between HRCT patterns and pathologic findings, summarizing the most common causes, as well as detailing the methods of investigation employed in order to diagnose the most common types of chronic diffuse lung disease.Keywords: Lung diseases, interstitial/pathology; Tomography, X-Ray computed; Diagnostic techniques, respiratory system. ResumoA tomografia de alta resolução (TCAR) é a técnica de imagem radiológica que reflete mais de perto as alterações da estrutura pulmonar. Os vários achados tomográficos podem ser combinados para formar padrões típicos. Estes, conjuntamente com a distribuição anatômica dos achados, e com os dados clínicos, podem estreitar o diagnóstico das doenças intersticiais pulmonares difusas, e em vários casos sugerir o diagnóstico correto com alto grau de acurácia. Os padrões mais comuns das doenças intersticiais pulmonares difusas na TCAR são o nodular, linear e reticular, lesões císticas, opacidades em vidro fosco e consolidações. Este artigo revisa as correlações entre os padrões tomográficos na TCAR e os achados patológicos e resume as causas mais comuns e os métodos de investigação para se atingir um diagnóstico nas doenças pulmonares crônicas difusas mais comuns.Descritores: Doenças pulmonares intersticiais/patologia; Tomografia computadorizada por raios X; Técnicas de diagnóstico do sistema respiratório.* Study carried out in the

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Isolated Diffuse Ground-Glass Opacity in Thoracic CT: Causes and Clinical Presentations

Cited by 88 publications

References 86 publications

Lung Ultrasonography May Provide an Indirect Estimation of Lung Porosity and Airspace Geometry

Lung Ultrasonography May Provide an Indirect Estimation of Lung Porosity and Airspace Geometry

Sonographic Interstitial Syndrome

Padrões tomográficos das doenças intersticiais pulmonares difusas com correlação clínica e patológica

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