Of the patients who had ground-glass opacities, 11 (15%) also had interlobular septal thickening, characterizing a crazy-paving pattern. b) At 21years old, the ground glass infiltrate appears more diffuse, and smooth interlobular septal thickening is present (arrow). baseline. 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. Lymphangioleiomyomatosis is characterized by the presence of lung cysts. 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 … Reticular opacities are related to interstitial edema secondary to obstruction of the lymphatic vessels, an uncommon finding in this illness ( Fig 6 ). Image/Video details. 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 … Each of these findings tends to be nonspecific and has a long differential diagnosis. This image reveals diffuse, bilateral, ground-glass opacity that is associated with mild, interlobular septal thickening. These differences are true of asbestosis without pleural disease. 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 Nodules as small as 1-2 mm in diameter can be detected by HRCT. 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 … Figure 1 – CT image of the chest shows focal ground-glass opacity located in the right upper and lower lobes. Abnormalities characterized by increased lung opacity can be divided into two categories based upon their attenuation: ground glass opacity (GGO) and consolidation. 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. Some of them have a rounded shape and interlobular septal thickening; note new ground-glass opacities in Figure 1B. Clinical information, particularly the duration of symptoms, can limit the diagnosis when either of these findings is present. Interlobular septal thickening, centrilobular nodular nodules, and ground glass opacities are frequently observed on chest computed tomography (CT). No signs of clubbing, vasculitis or heart failure were identified. 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. Chest computed tomography revealed non‐segmental subpleural consolidation, ground‐glass opacities, and interlobular septal thickening. Mosaic perfusion resulting from air trapping is more common in asbestosis than in idiopathic pulmonary fibrosis. ground glass infiltrate which has a geographic configuration; consisting of sharp demarcation between the infiltrate and normal lung. The chest radiograph showed diffuse bilateral infiltrative shadows, mainly in the upper segments. Interstitial thickening, residual ground-glass opacities, hypoinflation/volume loss, and bronchiectasis were the main findings. Diffuse, smooth septal thickening and several small areas of ground-glass opacities (arrows). 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 … 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 HRCT patterns were smooth interlobular septal thickening and ground-glass opacities, which were both present in all patients. Furthermore, interlobular septal thickening and Figure legend: Axial unenhanced CT image of the chest shows patchy peripheral areas of gound-glass opacity (arrow). Radiologic characteristics suggestive of PVOD on high-resolution CT of the chest include nodular ground-glass opacities, septal lines, and lymph node enlargement. Of the patients who had ground-glass opacities, 11 (15%) also had interlobular septal thickening, characterizing a crazy-paving pattern. The Clinical and Chest CT Features Associated With Severe and Critical COVID-19 Pneumonia (Kunhua, June 2020). HRCT scan of the chest showing nodular interlobular septal thickening at the lung bases, particularly at the right lung base (arrows). Note associated interlobular septal thickening (circle) within the ground-glass opacities in a so-called crazy-paving pattern. 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 … ground-glass opacities and consolidations in the same patient was observed in 41 cases (58%). 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). •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 e274 CHEST Pearls [158#6CHESTDECEMBER 2020] 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. Ground-glass opacities and interlobular septal thickening are common in both diseases. 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. Lymphangitic carcinomatosis: irregular septal thickening, usually focal or unilateral, in 50% adenopathy, known carcinoma. Other atypical and variable radiographic patterns, including lung nodules, masses, lobar consolidation, bronchiectasis, and bronchiolitis, have also been reported ( 22 ). 8A and 8B ). Intralobular … 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 … 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. 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. No interlobular septal thickening is evident. 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. Occasionally, interlobular septal lines are overlapped by ground-glass opacities, producing an appearance referred to as crazy paving . 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). Interlobular septal thickening, thickening of the adjacent pleura, nodules, round cystic changes, bronchiolectasis, pleural effusion, and lymphadenopathy were rarely observed in this group. Areas of ground-glass opacity associated with bronchiecta- sis and bronchiolectasis may also coexist, but areas of pure Ground glass opacities, interlobular septal thickening and consolidations were consistent HRCT manifestations in both metapneumovirus infection and SARS. 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%). Only 6 patients had no ground-glass opacities, consolidations, or a combination of both. Recent CXR showed bibasilar ground glass infiltrates. 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 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. What is Ground Glass Opacity & Why Is It Seen In COVID-19 Scans Understanding GGO. 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. The main HRCT findings are ground-glass opacities, interlobular septal thickening, crazy paving pattern, pleural effusion, and peribronchovascular interstitial thickening . The bronchoalveolar lavage (BAL) and transbronchial lung biopsy confirmed a diagnosis of drug‐induced interstitial lung disease (ILD) associated with dasatinib. Figures 1A and 2A show subtle peripheral ground-glass opacities in the lower lobes. 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%). 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 … 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. Asbestosis (peripheral interlobular septal thickening, subpleural findings, parenchymal lines, pleural plaques) 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. Only 6 patients had no ground-glass opacities, consolidations, or a combination of both. Less common findings include increased blood vessel diameter, consolidations, airspace nodules, and the reversed halo sign (Figs. We encountered a patient with ECD whose chest CT initially showed diffuse small randomly distributed nodules, resembling miliary … 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. 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