Differential Diagnosis for Diffuse Bilateral Interstitial Ground Glass Opacities in Lungs
Single Most Likely Diagnosis
- Viral Pneumonia: This is often the most common cause of diffuse bilateral interstitial ground glass opacities, especially in the context of a viral pandemic like COVID-19. The presentation can vary but often includes symptoms such as fever, cough, and shortness of breath.
Other Likely Diagnoses
- Atypical Bacterial Pneumonia: Caused by organisms like Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila. These infections can present with interstitial infiltrates on imaging and are more common in certain age groups or populations.
- Interstitial Lung Disease (ILD): Conditions such as nonspecific interstitial pneumonia (NSIP), cryptogenic organizing pneumonia (COP), and lymphocytic interstitial pneumonia (LIP) can present with ground glass opacities. The clinical context, including symptoms and exposures, helps narrow down the specific type of ILD.
- Pulmonary Edema: Not typically considered a primary interstitial process but can cause ground glass opacities, especially if cardiogenic in nature. The distribution might be more central (perihilar) than peripheral.
Do Not Miss Diagnoses
- Pneumocystis jirovecii Pneumonia (PCP): Especially in immunocompromised patients, this opportunistic infection can cause diffuse ground glass opacities and is critical to diagnose early due to its high mortality rate if untreated.
- Invasive Mold Infections: In severely immunocompromised patients, infections like invasive aspergillosis can present with ground glass opacities and are medical emergencies.
- Acute Respiratory Distress Syndrome (ARDS): While not a specific diagnosis, ARDS is a clinical syndrome that can result from various causes, including pneumonia, and is characterized by diffuse ground glass opacities on imaging. It requires prompt recognition and management.
Rare Diagnoses
- Lymphangitic Carcinomatosis: Metastatic disease to the lymphatics of the lung can cause interstitial markings and ground glass opacities, though this is less common.
- Eosinophilic Pneumonia: Characterized by an eosinophilic infiltration of the lungs, which can cause ground glass opacities. This condition can be acute or chronic and may be associated with specific exposures or medications.
- Alveolar Proteinosis: A rare condition characterized by the accumulation of surfactant-like protein and phospholipids in the alveoli, leading to ground glass opacities on imaging. It can be primary or secondary to other conditions.