Infection
Inflammation
Aspiration
70F Aspiration and Pneumonia with Crazy Paving Ashley Davidoff MD TheCommonVein.net crazy paving ICU 003
70F Aspiration and Pneumonia with Crazy Paving Ashley Davidoff MD TheCommonVein.net crazy paving ICU 002
70F Aspiration and Pneumonia with Crazy Paving Ashley Davidoff MD TheCommonVein.net
Crazy Paving ARDS Ashley Davidoff TheCommonVein.net ARDS-crazy-paving
Acute Eosinophillic Pneumonia Interlobular Septal Infiltration with Eosinophils and Inflammatory Exudate – Thickening of the Interlobular Septa – Crazy Paving Kerley B lines The diagram shows the thickened septum surrounding the secondary lobule due to an inflammatory process, cellular infiltrate and congestion of the venules and lymphatics in the septum (a) . An anatomic specimen of a secondary lobule from a patient with thickened interlobular septa is shown in c and overlaid in d. CT of the lungs in a patient with acute eosinophillic pneumonia shows thickened interlobular septa and centrilobular nodules and the thickened septa are overlaid in red (e). Ashley Davidoff MD The CommonVein.net lungs-0761
Neoplasm Malignant
Diffuse mucinous bronchioloalveolar carcinoma in a 78-year-old man. (a) High-resolution CT scan shows a bilateral crazy-paving pattern and centrilobular nodules. (b) Photomicrograph (original magnification, 400; hematoxylin-eosin stain) of a specimen from open lung biopsy shows replacement of the alveolar epithelium by epithelial neoplastic cells with abundant intracytoplasmic mucin (arrows). Rossi, S.E et al ?Crazy-Paving? Pattern at Thin-Section CT of the Lungs: RadiologicPathologic Overview Radiographics Volume 23 – Number 6, 2003
35 year old female with alveolar proteinosis Excellent example of crazy paving Ashley Davidoff TheCommonVein.net 117625
32469cd.jpg
CT scan through the chest shows diffuse ground glass changes with crazy paving, cardiomegaly with LV dilatation, and bilateral pleural effusions. the differential diagnosis includes amiodarone toxicity
Ashley Davidoff MD
CRAZY PAVING 57-year-old female with progressive dyspnea. CXR shows bilateral, diffuse alveolar opacities having a perihilar and basal distribution with sparing of the apices CT shows diffuse ground glass change with crazy paving morphology characterized by bilateral diffuse ground-glass opacities (GGO) with interlobular and intralobular septal thickening. There is a geographical distribution . Differential diagnosis ARDS PCP pneumonia CHF Alveolar Hemorrhage UIP Hypersensitivity Pneumonitis XRT pneumonitis COP Chronic Eosinophilic Lymphangitis Veno-Occlusive Disease Ashley Davidoff MD
CRAZY PAVING 57-year-old female with progressive dyspnea. CXR shows bilateral, diffuse alveolar opacities having a perihilar and basal distribution with sparing of the apices CT shows diffuse ground glass change with crazy paving morphology characterized by bilateral diffuse ground-glass opacities (GGO) with interlobular and intralobular septal thickening. There is a geographical distribution . Differential diagnosis ARDS PCP pneumonia CHF Alveolar Hemorrhage UIP Hypersensitivity Pneumonitis XRT pneumonitis COP Chronic Eosinophilic Lymphangitis Veno-Occlusive Disease Ashley Davidoff MD TheCommonVein.net
CRAZY PAVING 57-year-old female with progressive dyspnea. CXR shows bilateral, diffuse alveolar opacities having a perihilar and basal distribution with sparing of the apices CT shows diffuse ground glass change with crazy paving morphology characterized by bilateral diffuse ground-glass opacities (GGO) with interlobular and intralobular septal thickening. There is a geographical distribution . Differential diagnosis ARDS PCP pneumonia CHF Alveolar Hemorrhage UIP Hypersensitivity Pneumonitis XRT pneumonitis COP Chronic Eosinophilic Lymphangitis Veno-Occlusive Disease Ashley Davidoff MD
CRAZY PAVING 57-year-old female with progressive dyspnea. CXR shows bilateral, diffuse alveolar opacities having a perihilar and basal distribution with sparing of the apices CT shows diffuse ground glass change with crazy paving morphology characterized by bilateral diffuse ground-glass opacities (GGO) with interlobular and intralobular septal thickening. There is a geographical distribution . Differential diagnosis ARDS PCP pneumonia CHF Alveolar Hemorrhage UIP Hypersensitivity Pneumonitis XRT pneumonitis COP Chronic Eosinophilic Lymphangitis Veno-Occlusive Disease Ashley Davidoff MD
Crazy-paving sign. Axial CT of the chest shows thickening of the intralobular and interlobular septa with a superimposed background of ground-glass opacity in a patient with pulmonary alveolar proteinosis. Source Signs in Thoracic Imaging Journal of Thoracic Imaging 21(1):76-90, March 2006.
CRAZY PAVING IN ILD Crazy paving in ILD is a CT feature of interstitial lung disease and is characterised by diffuse ground glass caused by a combination of interlobular septal and intralobular septal thickening resulting well demarcated patchy densities in the lungs.
Infection
Inflammation
Desquamative Interstitial Pneumonia (DIP)
Diffuse Ground Glass Changes Lower Lung Fields and
Interlobular Septal Thickening (Crazy Paving)
CT Desquamative Interstitial Pneumonia (DIP) Diffuse Ground Glass Changes Lower Lung Fields and Interlobular Septal Thickening (Crazy Paving) 51-year-old female smoker with a history of COPD asthma and pulmonary hypertension presents with progressive dyspnea. Coronal CT through the posterior lungs shows diffuse ground glass changes in the lower lobes with interlobular septal thickening Pathology confirmed a diagnosis of DIP Ashley Davidoff MD TheCommonVein.net 252Lu 135997
Crack Lung
CT 1month Later Prominent Upper Lobe Interstitial and Parenchymal Changes 55 year old male with substance use disorder presents with progressive and now more severe dyspnea. CT through the mid lung fields shows extensive upper lobe and superior segmental lower lobe ground glass changes with thickening of the interlobular septa giving the appearance of ?crazy paving?. Thickening and irregularity of the major and middle fissures are also noted. There is bilateral peripheral sparing with a batwing distribution Progressive inhalational pneumonitis from smoking or cocaine inhalation was suspected. DIP and hypersensitivity pneumonitis remained in the differential diagnosis. (Crack Lung) Ashley Davidoff MD TheCommonVein.net 251Lu 135928
CT 1month Later Prominent Left Upper Lobe and Superior Segment of the Lower Lobe Ground Glass Parenchymal Changes 55-year-old male with substance use disorder presents with progressive and now more severe dyspnea. Sagittal CT through the left lung field shows ground glass changes in the upper mid and superior segment of the lower lobe. The fissures of the areas of involved lung are focally thickened. There is subpleural sparing. Progressive inhalational pneumonitis from smoking or cocaine inhalation was suspected. DIP and hypersensitivity pneumonitis remained in the differential diagnosis (Crack Lung) Ashley Davidoff MD TheCommonVein.net 251Lu 135942
Malignancy Mechanical/Atelectasis Trauma Metabolic Circulatory- Hemorrhage
Immune
Amiodarone Toxicity
CT 2 Days Later Ground Glass Changes and Crazy Paving Amiodarone Toxicity 75-year-old male with cardiomyopathy atrial fibrillation and treatment with amiodarone and a RUL infiltrate thought to be related to amiodarone therapy. There was no clinical evidence nor radiological evidence of heart failure. CT scan shows ground glass changes with multicentric crazy paving appearance that was thought to be related to amiodarone toxicity. bilateral small effusions are present, right greater than left. Following withdrawal of amiodarone and steroids administration he improved clinically and radiologically 3 months later confirming the probability of amiodarone toxicity Ashley Davidoff MD TheCommonVein.278 Lu 32471
Infiltrative Idiopathic Iatrogenic Idiopathic