Skip to main content

Increased Lung Attenuation

  • Chapter
  • First Online:
Computed Tomography of the Lung

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

  • 2524 Accesses

Abstract

The increased lung attenuation pattern develops when the amount of air in the airspaces and in the lumen of the airways decreases (resulting from lung volume decrease or from partial or total filling of the airspaces) and when the soft tissue structures increase in size and/or amount, two phenomena that often occur simultaneously. When the changes are limited, the increased lung opacity is described as being a “ground-glass opacity” referring to the presence on CT of a hazy increase in lung opacity that does not obscure the underlying vessels. When more pronounced, i.e. when the vessels are obscured, the term “lung consolidation” or “consolidation” is used. This chapter explains the different causes of these two types of increased lung attenuation patterns and describes the elements that can be helpful to make a differential diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Aberle DR, Gamsu G, Ray CS et al (1988) Asbestos-related pleural and parenchymal fibrosis: detection with high-resolution CT. Radiology 166:729–734

    Article  CAS  PubMed  Google Scholar 

  • Akira M, Kita N, Higashihara T et al (1992) Summer-type hypersensitivity pneumonitis: comparison of high-resolution CT and plain radiographic findings. AJR Am J Roentgenol 158:1223–1228

    Article  CAS  PubMed  Google Scholar 

  • Akira M, Atagi S, Kawahara M et al (1999) High-resolution CT findings of diffuse bronchioloalveolar carcinoma in 38 patients. AJR Am J Roentgenol 173:1623–1629

    Article  CAS  PubMed  Google Scholar 

  • Arakawa H, Webb WR, McCowin M et al (1998) Inhomogeneous lung attenuation at thin-section CT: diagnostic value of expiratory scans. Radiology 206:89–94

    Article  CAS  PubMed  Google Scholar 

  • Austin JH, Müller NL, Friedman PJ et al (1996) Glossary of terms for CT of the lungs: recommendations of the nomenclature Committee of the Fleischner Society. Radiology 200:327–331

    Article  CAS  PubMed  Google Scholar 

  • Bergin CJ, Wirth RL, Berry GJ et al (1990) Pneumocystis carinii pneumonia: CT and HRCT observations. J Comput Assist Tomogr 14:756–759

    Article  CAS  PubMed  Google Scholar 

  • Bernasconi A, Galleri C, Zanasi A et al (1988) Exogenous lipid pneumonia. Clinico-radiologic characteristics. Radiol Med 75(6):589–594

    CAS  PubMed  Google Scholar 

  • Bessis L, Callard P, Gotheil C et al (1992) High-resolution CT of parenchymal lung disease: precise correlation with histologic findings. Radiographics 12:45–58

    Article  CAS  PubMed  Google Scholar 

  • Bouchardy LM, Kuhlman JE, Ball WC et al (1993) CT findings in bronchiolitis obliterans organizing pneumonia (BOOP) with radiographic, clinical, and histologic correlation. J Comput Assist Tomogr 17:352–357

    Article  CAS  PubMed  Google Scholar 

  • Bourgouin P, Cousineau G, Lemire P et al (1987) Differentiation of radiation-induced fibrosis from recurrent pulmonary neoplasm by CT. Can Assoc Radiol J 38:23–26

    CAS  PubMed  Google Scholar 

  • Brauner MW, Grenier P, Mompoint D et al (1989) Pulmonary sarcoidosis: evaluation with high-resolution CT. Radiology 172:467–471

    Article  CAS  PubMed  Google Scholar 

  • Brauner MW, Lenoir S, Grenier P et al (1992) Pulmonary sarcoidosis: CT assessment of lesion reversibility. Radiology 182:349–354

    Article  CAS  PubMed  Google Scholar 

  • Castaner E, Alguersuani A, Gallardo X et al (2010) When to suspect pulmonary vasculitis: radiologic and clinical clues. Radiographics 30(1):33–53

    Article  PubMed  Google Scholar 

  • Castaner E, Alguersuani A, Andreu M et al (2012) Imaging findings in pulmonary vasculitis. Semin Ultrasound CT MR 33(6):567–579

    Article  PubMed  Google Scholar 

  • Cheon JE, Lee KS, Jung GS et al (1996) Acute eosinophilic pneumonia: radiographic and CT findings in six patients. AJR Am J Roentgenol 167:1195–1199

    Article  CAS  PubMed  Google Scholar 

  • Cluzel P, Grenier P, Bernadac P et al (1991) Pulmonary alveolar microlithiasis: CT findings. J Comput Assist Tomogr 15:938–942

    Article  CAS  PubMed  Google Scholar 

  • Collins J, Stern EJ (1997) Ground-glass opacity at CT: the ABCs. AJR Am J Roentgenol 169(2):355–367

    Article  CAS  PubMed  Google Scholar 

  • Cottin V, Chalabreysse L, Cordier JF (2008) Exogenous lipid pneumonia. Respiration 76(4):442–443

    Article  PubMed  Google Scholar 

  • Engeler CE, Tashjian JH, Trenkner SW et al (1993) Ground-glass opacity of the lung parenchyma: a guide to analysis with high-resolution CT. AJR Am J Roentgenol 160:249–251

    Article  CAS  PubMed  Google Scholar 

  • Franquet T (2001) Imaging of pneumonia: trends and algorithms. Eur Respir J 18(1):196–120

    Article  CAS  PubMed  Google Scholar 

  • Franquet T (2011) Imaging of pulmonary viral pneumonia. Radiology 260(1):18–39

    Article  PubMed  Google Scholar 

  • Franquet T, Giménez A, Bordes R et al (1998) The crazy-paving pattern in exogenous lipoid pneumonia: CT-pathologic correlation. AJR Am J Roentgenol 170:315–317

    Article  CAS  PubMed  Google Scholar 

  • Gevenois PA, Abehsera M, Knoop C et al (1994) Disseminated pulmonary ossification in end-stage pulmonary fibrosis: CT demonstration. AJR Am J Roentgenol 162:1303–1304

    Article  CAS  PubMed  Google Scholar 

  • Godoy MCB, Nonaka D, Lowy J (2010) Ground-glass centrilobular nodules on multidetector CT scan: incidental diagnosis in a patient with pneumonia. Chest 138(2):427–433

    Article  PubMed  Google Scholar 

  • Godwin JD, Müller NL, Takasugi JE (1988) Pulmonary alveolar proteinosis: CT findings. Radiology 169:609–613

    Article  CAS  PubMed  Google Scholar 

  • Graham CM, Stern EJ, Finkbeiner WE et al (1992) High-resolution CT appearance of diffuse alveolar septal amyloidosis. AJR Am J Roentgenol 158:265–267

    Article  CAS  PubMed  Google Scholar 

  • Graham NJ, Müller NL, Miller RR et al (1991) Intrathoracic complications following allogeneic bone marrow transplantation: CT findings. Radiology 181:153–156

    Article  CAS  PubMed  Google Scholar 

  • Gruden JF, Webb WR (1993) CT findings in a proved case of respiratory bronchiolitis. AJR Am J Roentgenol 161:44–46

    Article  CAS  PubMed  Google Scholar 

  • Gruden JF, Huang L, Turner J et al (1997) High-resolution CT in the evaluation of clinically suspected pneumocystis carinii pneumonia in AIDS patients with normal, equivocal, or non-specific radiographic findings. AJR Am J Roentgenol 169:967–975

    Article  CAS  PubMed  Google Scholar 

  • Hansell DM, Bankier A, MacMahon H et al (2008) Fleischner society: glossary of terms for thoracic imaging. Radiology 246:697–722

    Article  PubMed  Google Scholar 

  • Haroon A, Higa F, Haranaga S et al (2013) Differential diagnosis of non-segmental consolidations. J Pulmon Resp Med S8:001. doi:10.4172/2161-105X.S8-001

    Google Scholar 

  • Hartman TE, Müller NL, Primack SL et al (1994) Metastatic pulmonary calcification in patients with hypercalcemia: findings on chest radiographs and CT scans. AJR Am J Roentgenol 162:799–802

    Article  CAS  PubMed  Google Scholar 

  • Helbich TH, Wojnarovsky C, Wunderbaldinger P et al (1997) Pulmonary alveolar microlithiasis in children: radiographic and high-resolution CT findings. AJR Am J Roentgenol 168:63–65

    Article  CAS  PubMed  Google Scholar 

  • Holt RM, Schmidt RA, Godwin JD et al (1993) High resolution CT in respiratory bronchiolitis-associated interstitial lung disease. J Comput Assist Tomogr 17:46–50

    Article  CAS  PubMed  Google Scholar 

  • Hommeyer SH, Godwin JD, Takasugi HE (1991) Computed tomography of airspace disease. Radiol Clin N Am 29:1065–1084

    CAS  PubMed  Google Scholar 

  • Howell J, Permutt S, Proctor D et al (1961) Effect of inflation of the lung on different parts of pulmonary vascular bed. J Appl Physiol 16:71–76

    CAS  PubMed  Google Scholar 

  • Ikezoe J, Takashima S, Morimoto S et al (1988) CT appearance of acute radiation-induced injury in the lung. AJR Am J Roentgenol 150:765–770

    Article  CAS  PubMed  Google Scholar 

  • Ikezoe J, Morimoto S, Takashima S et al (1990) Acute radiation-induced pulmonary injury: computed tomographic evaluation. Semin Ultrasound CT MR 11:409–416

    CAS  PubMed  Google Scholar 

  • Im JG, Itoh H, Shim YS et al (1993) Pulmonary tuberculosis: CT findings – early active disease and sequential change with antituberculous therapy. Radiology 186:653–660

    Article  CAS  PubMed  Google Scholar 

  • Im JG, Kim SH, Chung MJ et al (1996) Lobular low attenuation of the lung parenchyma on CT: evaluation of forty-eight patients. J Comput Assist Tomogr 20:756–762

    Article  CAS  PubMed  Google Scholar 

  • Jeong Y, Kim K, Seo I et al (2007) Eosinophilic lung diseases: a clinical, radiologic, and pathologic overview. Radiographics 27(3):617–637

    Article  PubMed  Google Scholar 

  • Johkoh T, Ikezoe J, Nagareda T et al (1993) Metastatic pulmonary calcification: early detection by high-resolution CT. J Comput Assist Tomogr 17:471–473

    Article  CAS  PubMed  Google Scholar 

  • Johkoh T, Ikezoe J, Kohno N et al (1996) Usefulness of high-resolution CT for differential diagnosis of multi-focal pulmonary consolidation. Radiat Med 14(3):139–146

    CAS  PubMed  Google Scholar 

  • Johkoh T, Itoh H, Müller NL et al (1999a) Crazy-paving appearance at thin-section CT: spectrum and pathologic findings. Radiology 211:155–160

    Article  CAS  PubMed  Google Scholar 

  • Johkoh T, Müller NL, Ichikado K et al (1999b) Perilobular pulmonary opacities: high-resolution CT findings and pathologic correlation. J Thorac Imaging 14:172–177

    Article  CAS  PubMed  Google Scholar 

  • Kaneko K, Milic-Emili J, Dolovich MB et al (1966) Regional distribution of ventilation and perfusion as a function of body position. J Appl Physiol 21:767–777

    CAS  PubMed  Google Scholar 

  • Kim HY, Im JG, Song KS et al (1999) Localized amyloidosis of the respiratory system: CT features. J Comput Assist Tomogr 23(4):627–631

    Article  CAS  PubMed  Google Scholar 

  • Korn MA, Schurawitzki H, Klepetko W et al (1992) Pulmonary alveolar microlithiasis: findings on high-resolution CT. AJR Am J Roentgenol 158:981–982

    Article  CAS  PubMed  Google Scholar 

  • Kuhlman JE (1991) The role of chest computed tomography in the diagnosis of drug-related reactions. J Thorac Imaging 6:52–61

    Article  CAS  PubMed  Google Scholar 

  • Kuhlman JE, Ren H, Hutchins GM et al (1989) Fulminant pulmonary calcification complicating renal transplantation: CT demonstration. Radiology 173:459–460

    Article  CAS  PubMed  Google Scholar 

  • Kuhlman JE, Teigen C, Ren H et al (1990) Amiodarone pulmonary toxicity: CT findings in symptomatic patients. Radiology 177:121–125

    Article  CAS  PubMed  Google Scholar 

  • Lee Y, Choi Y, Lee K et al (2005) CT halo sign: the spectrum of pulmonary diseases. Br J Radiol 78(933): 862–865

    Google Scholar 

  • Leung AN, Miller RR, Müller NL (1993) Parenchymal opacification in chronic infiltrative lung diseases: CT-pathologic correlation. Radiology 188:209–214

    Article  CAS  PubMed  Google Scholar 

  • Libshitz HI, Shuman LS (1984) Radiation-induced pulmonary change: CT findings. J Comput Assist Tomogr 8:15–19

    Article  PubMed  Google Scholar 

  • Lynch DA, Brasch RC, Hardy KA et al (1990) Pediatric pulmonary disease: assessment with high-resolution ultrafast CT. Radiology 176:243–248

    Article  CAS  PubMed  Google Scholar 

  • MacMahon H, Naidich D, Goo M et al (2017) Guidelines for Management of incidental Pulmonary nodules Detected on cT images: From the Fleischner Society 2017. Radiology 284(1):228–243

    Google Scholar 

  • Marchiori E, Souza AS, Franquet T et al (2005) Diffuse high-attenuation pulmonary abnormalities: a pattern-oriented diagnostic approach on high-resolution CT. AJR Am J Roentgenol 184:273–282

    Article  PubMed  Google Scholar 

  • Marchiori E, Godoy MC, Zanetti G et al (2011) The reversed halo sign. Another CT finding useful for distinguish invasive pulmonary aspergillosis and pulmonary lymphoma. Eur J Radiol 79(2):e96–e97

    Article  PubMed  Google Scholar 

  • Marti-Bonmati L, Ruiz PF, Catala F et al (1989) CT findings in Swyer-James syndrome. Radiology 172:477–480

    Article  CAS  PubMed  Google Scholar 

  • Martin SG, Kronek LP, Valeyre D et al (2010) High-resolution computed tomography to differentiate chronic diffuse interstitial lung diseases with predominant ground-glass pattern using logical analysis of data. Eur Radiol 20(6):1297–1310

    Article  PubMed  Google Scholar 

  • Mayo JR, Müller NL, Road J et al (1989) Chronic eosinophilic pneumonia: CT findings in six cases. AJR Am J Roentgenol 153:727–730

    Article  CAS  PubMed  Google Scholar 

  • McCullough RL (1983) CT-number variability in thoracic geometry. Am J Roentgenol 141:135–140

    Article  CAS  Google Scholar 

  • McGuinness G, Scholes JV, Garay SM et al (1994) Cytomegalovirus pneumonitis: spectrum of parenchymal CT findings with pathologic correlation in 21 AIDS patients. Radiology 192:451–459

    Article  CAS  PubMed  Google Scholar 

  • Millar AB, Denison DM (1989) Vertical gradients of lung density in healthy supine men. Thorax 44:485–490

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Moskovic E, Miller R, Pearson M (1990) High-resolution computed tomography of pneumocystis carinii pneumonia in AIDS. Clin Radiol 42:239–243

    Article  CAS  PubMed  Google Scholar 

  • Müller NL, Miller RR (1993) Ground-glass attenuation: nodules, alveolitis, and sarcoid granulomas (editorial). Radiology 189:31–32

    Article  PubMed  Google Scholar 

  • Müller NL, Staples CA, Miller RR et al (1987) Disease activity in idiopathic pulmonary fibrosis: CT and pathologic correlation. Radiology 165:731–734

    Article  PubMed  Google Scholar 

  • Müller NL, Staples CA, Miller RR (1990) Bronchiolitis obliterans organizing pneumonia: CT features in 14 patients. AJR Am J Roentgenol 154(5):983–987

    Article  PubMed  Google Scholar 

  • Murata K, Khan A, Herman PG (1989) Pulmonary parenchymal disease: evaluation with high-resolution CT. Radiology 170:629–635

    Article  CAS  PubMed  Google Scholar 

  • Murata K, Takahashi M, Mori M et al (1996) Peribronchovascular interstitium of the pulmonary hilum: normal and abnormal findings on thin-section electron-beam CT. AJR Am J Roentgenol 166:309–312

    Article  CAS  PubMed  Google Scholar 

  • Murayama S, Murakami J, Yabuuchi H et al (1999) “Crazy-paving appearance” on high resolution CT in various diseases. J Comput Assist Tomogr 23:749–752

    Article  CAS  PubMed  Google Scholar 

  • Murch CR, Carr DH (1989) Computed tomography appearances of pulmonary alveolar proteinosis. Clin Radiol 40:240–243

    Article  CAS  PubMed  Google Scholar 

  • Murdoch J, Müller NL (1992) Pulmonary sarcoidosis: changes on follow-up CT examinations. AJR Am J Roentgenol 159:473–477

    Article  CAS  PubMed  Google Scholar 

  • Naidich DP, Zerhouni EA, Hutchins GM et al (1985) Computed tomography of the pulmonary parenchyma: part 1. Distal airspace disease. J Thorac Imaging 1:39–53

    Article  CAS  PubMed  Google Scholar 

  • Nastran H, Narinder G, Vijay B (2011) Bony metaplasia in interstitial lung disease. Chest 140(4):119A–119A

    Article  Google Scholar 

  • Patsios D, Roberts HC, Paul NS et al (2007) Pictorial review of the many faces of bronchioloalveolar cell carcinoma. Br J Radiol 80(960):1015–1023

    Article  CAS  PubMed  Google Scholar 

  • Permutt S, Howell J, Proctor D et al (1961) Effect of lung inflation on static pressure-volume characteristics of pulmonary vessels. J Appl Physiol 16:64–70

    CAS  PubMed  Google Scholar 

  • Primack SL, Hartman TE, Ikezoe J et al (1993) Acute interstitial pneumonia: radiographic and CT findings in nine patients. Radiology 188:817–820

    Article  CAS  PubMed  Google Scholar 

  • Reittner P, Müller NL, Heyneman L et al (1999) Mycoplasma pneumoniae pneumonia: radiographic and high-resolution CT features in 28 patients. AJR Am J Roentgenol 174:37–41

    Article  Google Scholar 

  • Remy-Jardin M, Beuscart R, Sault MC et al (1990a) Subpleural micronodules in diffuse infiltrative lung diseases: evaluation with thin-section CT scans. Radiology 177:133–139

    Article  CAS  PubMed  Google Scholar 

  • Remy-Jardin M, Degreef JM, Beuscart R et al (1990b) Coal worker’s pneumoconiosis: CT assessment in exposed workers and correlation with radiographic findings. Radiology 177:363–371

    Article  CAS  PubMed  Google Scholar 

  • Remy-Jardin M, Giraud F, Remy J et al (1993a) Importance of ground-glass attenuation in chronic diffuse infiltrative lung disease: pathologic CT correlation. Radiology 189:693–698

    Article  CAS  PubMed  Google Scholar 

  • Remy-Jardin M, Remy J, Gosselin B et al (1993b) Lung parenchymal changes secondary to cigarette smoking: pathologic CT correlations. Radiology 186:643–651

    Article  CAS  PubMed  Google Scholar 

  • Remy-Jardin M, Remy J, Giraud F (1993c) Computed tomography assessment of ground-glass opacity: semiology and significance. J Thorac Imaging 8(4):249–264

    Article  CAS  PubMed  Google Scholar 

  • Rosenblum LJ, Mauceri RA, Wellenstein DE et al (1978) Computed tomography of the lung. Radiology 129:521–524

    Article  CAS  PubMed  Google Scholar 

  • Rosenblum LJ, Mauceri RA, Wellenstein DE et al (1980) Density patterns in the normal lung as determined by computed tomography. Radiology 137:409–416

    Article  CAS  PubMed  Google Scholar 

  • Silver SF, Müller NL, Miller RR et al (1989) Hypersensitivity pneumonitis: evaluation with CT. Radiology 173:441–445

    Article  CAS  PubMed  Google Scholar 

  • Storto ML, Kee ST, Golden JA et al (1995) Hydrostatic pulmonary edema: high-resolution CT findings. AJR Am J Roentgenol 165:817–820

    Article  CAS  PubMed  Google Scholar 

  • Tan RT, Kuzo RS (1997) High-resolution CT findings of mucinous bronchioloalveolar carcinoma: a case of pseudopulmonary alveolar proteinosis. AJR Am J Roentgenol 168:99–100

    Article  CAS  PubMed  Google Scholar 

  • Traill ZC, Maskell GF, Gleeson FV (1997) High-resolution CT findings of pulmonary sarcoidosis. AJR Am J Roentgenol 168:1557–1660

    Article  CAS  PubMed  Google Scholar 

  • Tuddenham WJ (1984) Glossary of terms for thoracic radiology: recommendations of the nomenclature Committee of the Fleischner Society. AJR Am J Roentgenol 143:509–517

    Article  CAS  PubMed  Google Scholar 

  • Verschakelen JA, Van Fraeyenhoven L, Laureys G et al (1993) Differences in CT density between dependent and nondependent portions of the lung: influence of lung volume. AJR Am J Roentgenol 161:713–717

    Article  CAS  PubMed  Google Scholar 

  • Vieira IG, Marchiori E, Zanetti G et al (2009) Pulmonary amyloidosis with calcified nodules and masses - a six-year computed tomography follow-up: a case report. Cases J 2:6540

    Article  PubMed  PubMed Central  Google Scholar 

  • Wandtke JC, Hyde RW, Fahey PJ et al (1986) Measurement of lung gas volume and regional density by computed tomography in dogs. Investig Radiol 21:108–117

    Article  CAS  Google Scholar 

  • Webb WR (1989) High-resolution CT of the lung parenchyma. Radiol Clin N Am 27:1085–1097

    CAS  PubMed  Google Scholar 

  • Webb WR (1994) High-resolution computed tomography of obstructive lung disease. Radiol Clin N Am 32:745–757

    CAS  PubMed  Google Scholar 

  • Webb WR, Müller NL, Naidich DP (1993a) Standardized terms for high-resolution computed tomography of the lung: a proposed glossary. J Thorac Imaging 8:167–185

    Article  CAS  PubMed  Google Scholar 

  • Webb WR, Stern EJ, Kanth N et al (1993b) Dynamic pulmonary CT: findings in healthy adult men. Radiology 186:117–124

    Article  CAS  PubMed  Google Scholar 

  • Wegener OH, Koeppe P, Oeser H (1978) Measurement of lung density by computed tomography. J Comput Assist Tomogr 2:263–273

    Article  CAS  PubMed  Google Scholar 

  • Wells AU, Hansell DM, Corrin B et al (1992) High resolution computed tomography as a predictor of lung histology in systemic sclerosis. Thorax 47:508–512

    Article  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer-Verlag Berlin Heidelberg

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Verschakelen, J.A., De Wever, W. (2018). Increased Lung Attenuation. In: Computed Tomography of the Lung. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-39518-5_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-39518-5_4

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-39517-8

  • Online ISBN: 978-3-642-39518-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics