The Common Vein

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Crazy Paving in Lung Disease
The Common Vein Copyright 2008
Ashley Davidoff MD
Crazy Paving Pattern is defined as scattered or diffuse ground-glass attenuation with superimposed interlobular septal thickening and intralobular lines. 
When the pattern of “crazy-paving” is present, alveolar proteinosis is most likely but lipoid pneumonia, bronchioloalveolar carcinoma, and pneumocystis pneumonia are included in the differential diagnosis.
 







This 74 year old female with severe COPD preents with increasing shortnes of breath.  There were extensive changes of interlobular septal thickening of the lungs bilaterally with ground glass changes in the left upper lobe.  the cause of the “crazy paving in this instance was not known but thought to represent an non specific interstitial pneumonitis.  Courtesy Ashley Davidoff MD


 



Pathologic Findings:   Interlobular Septal Thickening and Ground Glass Opacity

Pathologic Findings:    Alveolar Edema
                                    Interlobular septal thickening 
Causes
 INFECTION – pneumocystis
INFLAMMATION –  – ARDS
                            – sarcoidosis
                          – non specific interstitial pneumonia NSIP
                          – organizing pneumonia
                         – lipoid pneumonia (inhalational)                  
NEOPLASM – mucinous alveolar carcinoma
CIRCULATORY – pulmonary hemorrhage syndromes
IDIOPATHIC – pulmonary alveolar proteinosis PAP
 
Pearls:
Pulmonary alveolar proteinosis is most common in adults between 20 and50 years of age.  Dyspnea and nonproductive cough are the most common associated symptoms.
Nonspecific interstitial pneumonia (NSIP) and Organizing pneumonia may be induced by Methotrexate, Amiodarone or Bleomycin.  Honeycombing is typically absent.
Bronchioloalveolar carcinoma is characterized by a lepidic growth pattern through the airways and air spaces with preservation of the lung architecture.
References:
“Crazy-Paving” Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview, Radiographics 2003;23:1509-1519
Crazy-paving Appearance at Thin-Section CT: Spectrum of Disease and Pathologic Findings, Radiology 1999
CT-Pathology Correlations:  http://pathhsw5m54.ucsf.edu/ctpath/ctpath23.html 5*
/MA.



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Crazy Paving in Lung Disease
The Common Vein Copyright 2008
Ashley Davidoff MD
Crazy Paving Pattern is defined as scattered or diffuse ground-glass attenuation with superimposed interlobular septal thickening and intralobular lines. 
When the pattern of “crazy-paving” is present, alveolar proteinosis is most likely but lipoid pneumonia, bronchioloalveolar carcinoma, and pneumocystis pneumonia are included in the differential diagnosis.
 







This 74 year old female with severe COPD preents with increasing shortnes of breath.  There were extensive changes of interlobular septal thickening of the lungs bilaterally with ground glass changes in the left upper lobe.  the cause of the “crazy paving in this instance was not known but thought to represent an non specific interstitial pneumonitis.  Courtesy Ashley Davidoff MD


 



Pathologic Findings:   Interlobular Septal Thickening and Ground Glass Opacity

Pathologic Findings:    Alveolar Edema
                                    Interlobular septal thickening 
Causes
 INFECTION – pneumocystis
INFLAMMATION –  – ARDS
                            – sarcoidosis
                          – non specific interstitial pneumonia NSIP
                          – organizing pneumonia
                         – lipoid pneumonia (inhalational)                  
NEOPLASM – mucinous alveolar carcinoma
CIRCULATORY – pulmonary hemorrhage syndromes
IDIOPATHIC – pulmonary alveolar proteinosis PAP
 
Pearls:
Pulmonary alveolar proteinosis is most common in adults between 20 and50 years of age.  Dyspnea and nonproductive cough are the most common associated symptoms.
Nonspecific interstitial pneumonia (NSIP) and Organizing pneumonia may be induced by Methotrexate, Amiodarone or Bleomycin.  Honeycombing is typically absent.
Bronchioloalveolar carcinoma is characterized by a lepidic growth pattern through the airways and air spaces with preservation of the lung architecture.
References:
“Crazy-Paving” Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview, Radiographics 2003;23:1509-1519
Crazy-paving Appearance at Thin-Section CT: Spectrum of Disease and Pathologic Findings, Radiology 1999
CT-Pathology Correlations:  http://pathhsw5m54.ucsf.edu/ctpath/ctpath23.html 5*
/MA.



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Crazy Paving in Lung Disease
The Common Vein Copyright 2008
Ashley Davidoff MD
Crazy Paving Pattern is defined as scattered or diffuse ground-glass attenuation with superimposed interlobular septal thickening and intralobular lines. 
When the pattern of “crazy-paving” is present, alveolar proteinosis is most likely but lipoid pneumonia, bronchioloalveolar carcinoma, and pneumocystis pneumonia are included in the differential diagnosis.
 







This 74 year old female with severe COPD preents with increasing shortnes of breath.  There were extensive changes of interlobular septal thickening of the lungs bilaterally with ground glass changes in the left upper lobe.  the cause of the “crazy paving in this instance was not known but thought to represent an non specific interstitial pneumonitis.  Courtesy Ashley Davidoff MD


 



Pathologic Findings:   Interlobular Septal Thickening and Ground Glass Opacity

Pathologic Findings:    Alveolar Edema
                                    Interlobular septal thickening 
Causes
 INFECTION – pneumocystis
INFLAMMATION –  – ARDS
                            – sarcoidosis
                          – non specific interstitial pneumonia NSIP
                          – organizing pneumonia
                         – lipoid pneumonia (inhalational)                  
NEOPLASM – mucinous alveolar carcinoma
CIRCULATORY – pulmonary hemorrhage syndromes
IDIOPATHIC – pulmonary alveolar proteinosis PAP
 
Pearls:
Pulmonary alveolar proteinosis is most common in adults between 20 and50 years of age.  Dyspnea and nonproductive cough are the most common associated symptoms.
Nonspecific interstitial pneumonia (NSIP) and Organizing pneumonia may be induced by Methotrexate, Amiodarone or Bleomycin.  Honeycombing is typically absent.
Bronchioloalveolar carcinoma is characterized by a lepidic growth pattern through the airways and air spaces with preservation of the lung architecture.
References:
“Crazy-Paving” Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview, Radiographics 2003;23:1509-1519
Crazy-paving Appearance at Thin-Section CT: Spectrum of Disease and Pathologic Findings, Radiology 1999
CT-Pathology Correlations:  http://pathhsw5m54.ucsf.edu/ctpath/ctpath23.html 5*
/MA.
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Crazy Paving in Lung Disease
The Common Vein Copyright 2008
Ashley Davidoff MD
Crazy Paving Pattern is defined as scattered or diffuse ground-glass attenuation with superimposed interlobular septal thickening and intralobular lines. 
When the pattern of “crazy-paving” is present, alveolar proteinosis is most likely but lipoid pneumonia, bronchioloalveolar carcinoma, and pneumocystis pneumonia are included in the differential diagnosis.
 







This 74 year old female with severe COPD preents with increasing shortnes of breath.  There were extensive changes of interlobular septal thickening of the lungs bilaterally with ground glass changes in the left upper lobe.  the cause of the “crazy paving in this instance was not known but thought to represent an non specific interstitial pneumonitis.  Courtesy Ashley Davidoff MD


 



Pathologic Findings:   Interlobular Septal Thickening and Ground Glass Opacity

Pathologic Findings:    Alveolar Edema
                                    Interlobular septal thickening 
Causes
 INFECTION – pneumocystis
INFLAMMATION –  – ARDS
                            – sarcoidosis
                          – non specific interstitial pneumonia NSIP
                          – organizing pneumonia
                         – lipoid pneumonia (inhalational)                  
NEOPLASM – mucinous alveolar carcinoma
CIRCULATORY – pulmonary hemorrhage syndromes
IDIOPATHIC – pulmonary alveolar proteinosis PAP
 
Pearls:
Pulmonary alveolar proteinosis is most common in adults between 20 and50 years of age.  Dyspnea and nonproductive cough are the most common associated symptoms.
Nonspecific interstitial pneumonia (NSIP) and Organizing pneumonia may be induced by Methotrexate, Amiodarone or Bleomycin.  Honeycombing is typically absent.
Bronchioloalveolar carcinoma is characterized by a lepidic growth pattern through the airways and air spaces with preservation of the lung architecture.
References:
“Crazy-Paving” Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview, Radiographics 2003;23:1509-1519
Crazy-paving Appearance at Thin-Section CT: Spectrum of Disease and Pathologic Findings, Radiology 1999
CT-Pathology Correlations:  http://pathhsw5m54.ucsf.edu/ctpath/ctpath23.html 5*
/MA.
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