The relative frequencies of causes of widespread ground-glass opacity: A retrospective cohort
Introduction
Ground-glass opacity (GGO) is a commonly identified abnormality on computed tomography (CT) but is nonspecific with a broad differential diagnosis. While focal ground-glass opacity in the form of a nodule currently garners the most attention in the literature and in everyday clinical practice, widespread ground-glass opacity is a not infrequently encountered finding that can pose a diagnostic dilemma for radiologists and clinicians alike. Widespread GGO covers the gamut of disease processes, seen in both acute alveolar filling processes and in chronic interstitial diseases [1], [2]. However, when widespread GGO is seen as the dominant or as an isolated imaging finding, the cause is generally due to a limited group of diseases [3].
The purpose of our study was to determine the relative frequencies of causes of widespread ground-glass opacity in an unselected, consecutive patient population and to identify any associated imaging findings that can narrow or at least reorganize the differential.
Section snippets
Study design
The study was approved by the center's institutional review board (IRB#7, Protocol #813882) and is Health Insurance Portability and Accountability Act compliant. For inclusion into the study the following criteria had to be met: (1) The patient had a CT of the chest performed at our institution that demonstrated widespread ground glass opacity as the predominant finding on the examination. (2) The patient had a medical record at our institution available for review.
Our Radiology Information
Patient population
There were a total of 124 women and 110 men with a mean age of 53.7 years. There were 159 Caucasians, 56 African Americans, 10 Hispanics and 9 Asians. Presenting symptoms included dyspnea (n = 189), cough (n = 12), chest pain (n = 8), hemoptysis (n = 22), and fever (n = 14). 50 patients were immunocompromised due to HIV (n = 6), solid organ transplantation (n = 8), bone marrow transplantation (n = 3), lymphoproliferative malignancy (n = 19), cancer chemotherapy (n = 18). 20 patients had more than one cause of
Discussion
Prior studies of diffuse ground glass opacity have relied on histologic or microbiologic diagnosis of causes. This approach has the advantage of definitively identifying the cause. However, this method has the distinct disadvantage of excluding or under-reporting certain causes, which are traditionally diagnosed on clinical grounds and over-reporting causes that are more easily made, such as infectious diseases. Under-reporting is particularly a problem for diagnosis of hydrostatic pulmonary
Conflict of interest
None of the authors has any conflict of interest.
References (14)
Nonspecific interstitial pneumonia and usual interstitial pneumonia: is differentiation possible by high-resolution computed tomography?
Semin Ultrasound CT MR
(2014)- et al.
Ground-glass opacity of the lung parenchyma: guide to analysis with high resolution CT
AJR
(1993) - et al.
Importance of ground-glass attenuation in chronic diffuse infiltrative lung disease: pathologic-CT correlation
Radiology
(1993) - et al.
Isolated diffuse ground-glass opacity in thoracic CT: causes and clinical presentations
AJR
(2005) - et al.
Widespread ground-glass opacity of the lung in consecutive patients undergoing CT: does lobular distribution assist diagnosis?
AJR
(2003) - et al.
Hydrostatic pulmonary edema: high-resolution computed tomography aspects
J Bras Pneumol
(2006) - et al.
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)
Eur Heart J
(2008)
Cited by (16)
Diagnosis and Evaluation of Hypersensitivity Pneumonitis: CHEST Guideline and Expert Panel Report
2021, ChestCitation Excerpt :The evaluation of specific CT features of HP is essential for establishing the level of radiological confidence. A retrospective study evaluated the causes of widespread GGO and the utility of associated findings in distinguishing between causes of diffuse GGO on chest CT imaging in 234 consecutive inpatient and outpatient subjects with diffuse lung diseases.100 CT scan protocols were varied.
Executive Summary: Diagnosis and Evaluation of Hypersensitivity Pneumonitis: CHEST Guideline and Expert Panel Report
2021, ChestCitation Excerpt :In addition to the diagnostic limitations of LPT outlined in the recommendation remark, our confidence was further lowered because the utility of the LPT as a potential HP diagnostic tool depends on the accuracy of the exposure history and knowledge of the suspected IA. Nine studies evaluating the performance characteristics of HRCT scan of the chest for establishing the diagnosis of HP in patients with interstitial lung disease (ILD) were identified (see e-Table 10 from Fernández Pérez et al4).10,63-70 Although a high-probability scan is virtually diagnostic for HP in subjects with compelling exposure history, in patients with an indeterminate or unidentified environmental exposure, differentiating fibrotic HP from idiopathic pulmonary fibrosis (IPF) can be challenging.
COVID-19 and Crimean-Congo Hemorrhagic Fever: Similarities and Differences
2020, Heart and LungPneumocystis jirovecii pneumonia at chest High-resolution Computed Tomography (HRCT)in non-HIV immunocompromised patients: Spectrum of findings and mimickers
2019, European Journal of RadiologyCitation Excerpt :HRCT shows smooth septal thickening, GGO and consolidations, initially involving the peri-hilar regions, with symmetric and gravitational distribution (Fig. 11). Hydrostatic oedema is the main non-infectious cause of widespread GGO in hospitalized patients [59]. Bilateral pleural effusions and mediastinal findings (i.e., enlarged oedematous lymph nodes, and effacement of fat secondary to extravascular fluid) are frequently associated and help in confirming diagnosis [60].
Interstitial Lung Diseases
2023, The Thorax: Medical, Radiological, and Pathological AssessmentCrimean-Congo Hemorrhagic Fever in Differential Diagnosis During the Coronavirus Disease-2019 Pandemic
2022, Turkiye Parazitoloji Dergisi