Parte II: vidrio esmerilado – quistes

Ground glass and Cysts

Cornelia Schaefer-Prokop
Meander Medical Center Amersfoort
Radboud University Nijmegen
The Netherlands
Ground – Glass Opacity

Hazy increase in the

density of the lung
parenchyma on HRCT,
that does not obscure
the pulmonary
vasculature
Consolidation

Abnormal dense
opacification of the
lung parenchyma on
HRCT that obscures
lung vasculature
Black-Bronchus Sign
Pitfalls: Ground Glass ??

In expiration Inspiration
Pitfalls: Ground Glass ??

Noise Window/level
Pathology: Displacement of Air

By thickening of the interstitium,

by partial filling of the air spaces, or
by both
Graphics from ‚Diagnostic Imaging: Chest, AMIRSYS 2007
DD of “dominant” Ground Glass…..

ARDS / AIP
DIP
NSIP
RBILD
LIP
Edema
Alveolar proteinosis
Pulmonary hemorrhage / vasculitis
Subacute Hypersensitivity Pneumonitis
PjP infection, CMV infection
Adenocarcinoma with lepidic growth pattern (BAC)
Eosinophilic pneumonia
Radiation pneumonitis / Drug indiced lung disease
DD of “dominant” Ground Glass…..

……without additional signs,

a distinctive distribution and
no clinical information
ground glass opacity is a
truely nonspecific pattern
Ancillary Findings to refine DD…..

Nodularity
Lymph adenopathy
Cysts
Crazy paving
Associated traction bronchiectasis
Associated septal thickening
 Acinar Nodules

EAA

RB-ILD
Hypersensitivity Pneumonitis

Both pathological: GG and airtrapping

Ancillary Findings to refine DD…..

Nodularity
Lymph adenopathy
Cysts
Crazy paving
Associated traction bronchiectasis
Associated septal thickening
Alveolar Sarcoidosis
Sarcoidosis: look for Bronchiectasis
Ancillary Findings to refine DD…..

Nodularity
Lymph adenopathy
Cysts
Crazy paving
Associated traction bronchiectasis
Associated septal thickening
Lymphocytic Interstitial Pneumonia (LIP)
 Lymphocytic Interstitial Pneumonia
Benign lymphoprolif. disorder
Diffuse infiltration by mononuclear cells

Rarely idiopathic
Sjoegren
HIV
biliary cirrhosis
Castleman disease
Ancillary Findings to refine DD…..

Nodularity
Lymph adenopathy
Cysts
Crazy paving
Associated traction bronchiectasis
Associated septal thickening
Definition

Crazy Paving
• Intra- and interlobular
septae, superpositioned
over ground glass
• With or without
architectural distortion
Alveolar proteinosis
Differentialdiagnosis of Crazy paving
edema, bleeding, pneumonia, ARDS/AID,
interstitial fibrosis........

The alveoli are filled with…….

Diffuse Alveolar Hemorrhage
Edema...............“Alveolar Filling in“
DIP AIP

DIP = Desquamative Interstitial Pneumonia

AIP = Acute Interstitial Pneumonia
Diffuse Alveolar Damage (DAD)...........
Ancillary Findings to refine DD…..

Nodularity
Lymph adenopathy
Cysts
Crazy paving
Associated traction bronchiectasis
Associated septal thickening
No fibrosis / No architectural distorsion
Signs of Fibrosis / Architectural distorsion

Honeycombing Bronchiectasis
DIP …… acute NSIP….. Fibrosing NSIP
DD..........interlobular thickening

Cardiac Edema
edema Lymphangitis
lymphangitis Acute
Eosinophilic
Pneumonia
eosinophilic
pneumonia
Mosaic pattern

There is a separate
presentation.....
Increased Attenuation
ground glass and consolidations
Organizing Pneumonia
COP / OP
Etiology
Idiopathic = cryptogenic (COP)
OP as reaction after:
Following infections
Drug reaction
Collagen vascular diseases
Aspiration / toxic inhalation
Wegener‘s granulomatosis
Radiation
….various morphologies…..
 COP / OP: HRCT
Patchy / non-segmental consolidations 80-90%
subpleural 60%
Lower > upper parts
Multiple > solitary lesions
Perilobar pattern 60%
Bronchiectasis, bronchial wall thickening 60-80%
ill defined centrilobular nodules 30-50%
reversed Halo sign / Atoll sign
crazy paving / ground glass
Perilobular
pattern
Reversed Halo sign
Atoll sign

...a complete or incomplete ring

or crescent of consolidations
encompasses
a region of ground glass...
Consolidations around
bronchovascular budle

...sharply demarcated consolidations

encompasses
the bronchovascular bundle...
Summary

Ground glass is very unspecific

Look for secondary findings
lymph nodes, bronchiectasis, consoidations
Look for distribution and morphology
diffuse, patchy
CLINICAL information and
MULTIDISCIPLINARY approach
Holes in the lung….
Uniform Bizarre Thick walled no walls
thin walled thin walled microcysts centrilob.
cysts cysts

LAM Histiocytosis Honey Emphysema

combing
Do the holes have walls ?

Radiologie
Amsterdam Medical Center
Is there ground glass ?
Are there nodules ?
What is the morphology of the cysts ?
Where are the holes ?