When someone suffers from fever, cough, sputum production, breathlessness, chest pain, or coughing up of blood (hemoptysis), it could indicate a wide array of respiratory diseases or lung infections, say experts. Such infections show up on a typical chest X-ray of the lungs as hazy and cloudy patches in grey or white hues. The radiological term for this is lung opacity.
Once symptoms appear, a radiological analysis of the chest through a chest x-ray is the first line of testing after clinical examination, informs Dr Lokesh Gutta, consultant interventional pulmonologist, Manipal Hospital, Vijayawada. “The x-ray film shows the actual condition of the lungs and whether it is opaque. This helps in accurate diagnosis and treatment. Medical professionals can also request additional tests after seeing the reports,” he explains. In the case of an opaque lung, the radiographic image will show a decrease in the ratio of gas to soft tissues.
Causes of lung opacity
Apart from the presence of a tumor in the lungs, bacterial, fungal or viral infections can result in pulmonary opacity. Pneumonia and lung cancer are two common causes behind lung opacity, highlights Dr Manjunath PH, consultant interventional pulmonologist, BGS Gleneagles Global Hospitals, Bengaluru. “The other possible lung infections that cause opacification of the lung include interstitial lung disease, tuberculosis, acute pulmonary edema, acute respiratory distress syndrome,” explains Dr Athul Francis, consultant pulmonologist, MAJ Hospital, Ernakulam, Kerala.
Who is at risk?
Children below 10 years and adults above 65 years of age, immunocompromised individuals (such as people with type 1 diabetes, HIV, leukemia or lymphoma, lupus, rheumatoid arthritis, chronic liver disease and chronic kidney disease), those with a family history of lung cancer and those who smoke are at risk of developing pulmonary opacities, highlights Dr Manjunath.
How to identify the cause behind lung opacity?
Some factors about lung opacity can help to determine the type of respiratory illness causing it. The nodules are small, localized, rounded, grey or white patches in the lungs that create pulmonary opacities. These could be dense (more than 3 cm) or less dense. Dr Francis explains, “The nodules are examined for size, shape — circular, cylindrical, oval and others — and boundary, which could be circular, spiculated [with needle-like projections], eccentric and other patterns. This will help us understand if the respiratory illness is due to an infection or is cancerous.” He explains that a larger size or spiculated pattern of the nodule could indicate cancer. Otherwise, it could signify non-cancerous respiratory illnesses such as tuberculosis and pneumonia.
Tests for lung opacity
Dr Manjunath shares that a chest x-ray works best to understand cloudy lungs. However, it is simply considered the foundation for further diagnosis. It is routinely accompanied by complete blood count (CBC) and C-reactive protein (CRP) tests to understand the severity of the infection. The other confirmatory tests are:
Bronchoscopy: A procedure that involves inserting a camera through the lungs to check for blockages in airways. It is helpful in diagnosing tuberculosis, interstitial lung disease and other respiratory issues.
Bronchoalveolar lavage: This test usually accompanies bronchoscopy. It collects a fluid sample from the lungs to test for lung infection.
Computed tomography (CT Scan): It is a combination of x-ray images taken from various angles. A CT scan is often recommended to identify malignancy or cancer in the lungs.
Biopsy: This is done if there are lesions growing in the lungs. It is especially performed in those with a history of smoking.
The dangers of asymptomatic lung opacity
Opacification of the lungs without any symptoms can be dangerous, cautions Dr Francis. The silently growing nodules, showing no symptoms like cough or cold despite breathlessness, often get misdiagnosed or ignored, he informs. “Some nodules can be harmless, too. But, if they are growing and the breathlessness persists for more than three months, one must check for malignancy,” he warns.
If a person is a habitual smoker or is battling cancer, the typical signs of opaque lung could be absent, highlights Dr Francis. “Opacification of the lung is sometimes asymptomatic. As a result, some cases of lung cancer — typically in smokers — are not diagnosed early,” says Dr Francis.
Treatment and preventive measures
Pulmonary opacity is treated according to its causative factors. In the case of bacterial infection, treatment includes antibiotics. Anti-fungal medications help treat it if is due to a fungus, say experts. Dr Francis adds, “After treatment, cloudy lungs gradually become lighter or less dense.”
Dr Gutta highlights that while opacification of lungs and other related illnesses can be treated with an accurate diagnosis, prevention is always safer. This can be achieved through vaccination. He adds, “Children below 10 years of age and older people (above 60 years) must get the pneumococcal vaccination and influenza or flu shots as a preventive measure.”
Takeaways
- A chest x-ray indicates lung opacity (cloudy patches in grey or white hues).
- Symptoms such as fever, cough, sputum production, breathlessness, chest pain, or coughing up blood can signify lung opacity. However, it can be asymptomatic in some cases.
- After a chest x-ray, medical professionals can seek more pathological evidence, including bronchoscopy, CT scan or biopsy.
