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CONCLUSION: Crazy paving pattern caused by pulmonary alveolar proteinosis displayed clear edges, and smooth reticular opacities, most of which were due to hemangiectasis of interlobular, interacinar and interalveolar septa. crazy-paving pattern (i.e., smoothly thickened intralobular interstitial lines and interlobular septal lines against a background of wide-spread ground-glass opacities) often with lob- ular or geographic sparing [3, 4]. Very rarely, it also displays a “crazy paving” pattern (also described as a “paving stone,”“flagstone,” or “slabstone” pattern), which is rarer still in discrete bilateral nodules. The pattern observed is highly suggestive of the disease, although not pathognomonic. Acta Radiol. Correlations with reticulation are less unequivocal and could correspond to interstitial disease (lipoproteinaceous interstitial accumulation, inflammation or oedema) or lipoproteinaceous alveolar accumulation on the edges of the lobules [21]. Idiopathic Disorders Pulmonary Alveolar Proteinosis Nowadays this pattern is a common finding on high-resolution CT imaging, and can be seen in a number of acute and chronic diseases. A crazy paving pattern is the combination of enlarged pulmonary blood vessels and a hazy appearance in the lungs. 2. This is a CT-related term that refers to presence of pulmonary ground glass opacity with superimposed interlobular septal thickening and intralobular lines, resembling irregularly shaped paving stones. Imaging description The classic appearance of pulmonary alveolar proteinosis is symmetric, predominately perihilar, ground-glass opacity with intralobular linear opacities and interlobular septal thickening (“crazy-paving” pattern) [1–3] (Figures 19.1–19.4). Her chest computed tomography scan showed a bilateral crazy-paving pattern in both of her lungs. 5A, 5B). Bronchoalveolar lavage was performed, and a diagnosis of pulmonary alveolar proteinosis was made. Pulmonary alveolar proteinosis Sandeep M Patel MD1, Hiroshi Sekiguchi MD 2, Jordan P Reynolds MD3, ... ‘crazy-paving’ pattern that need to be considered and ruled out before making a diagnosis of PAP? She was severely hypoxemic, so we recommended whole lung lavage or inhaled granulocyte … Axial CT scan showing extensive areas of ground-glass attenuation and diffuse interlobular septal thickening in both lungs in a patient with pulmonary alveolar proteinosis. crazy paving pattern typical of pulmonary alveolar proteinosis (fi gure). Pulmonary Alveolar Proteinosis. images of the lung tissue and may reveal a “crazy paving” pattern. Crazy paving refers to a pattern seen on computed tomography of the chest, involving lobular septal thickening with variable alveolar filling. Pulmonary, Alveolar Proteinosis. • Autoimmune pulmonary alveolar proteinosis requires timely diagnosis. The pattern is caused by thickening of interlobular septa superimposed on areas of ground glass opacification. invasions. Crazy paving pattern caused by pulmonary alveolar proteinosis: CT findings and the pathologic basis (English) LUO Jianguang, YANG Dongyi, ZHOU Shunke, XIAO Enhua, CHEN Ping, FAN Songqing, LIU Jun: 1. The crazy-paving pattern found on computed tomography of the lungs is a nonspecific radiologic sign named after the appearance of paths made with pieces of stone or concrete. Pulmonary Alveolar Proteinosis (PAP) Am J Respir Crit Care Med Vol. This crazy paving pattern has been described as part of a characteristic appearance of pulmonary alveolar proteinosis (Fig. The crazy-paving pattern is a linear pattern superimposed on a background of ground-glass opacity, resembling irregularly shaped paving stones. In the lung, melanoma is mostly arranged as patterns of multiple nodules, solitary nodules, or miliary invasions. 24–26 It was first used to describe the pattern of pulmonary alveolar proteinosis, but can be seen in a variety of diseases. Reticulations are superimposed on ground-glass opacities forming a “crazy paving” pattern with a geographic distribution: juxtaposition of healthy and sick zones . Johkoh T, et al. The finding is seen in pulmonary alveolar proteinosis, and other diseases. Crazy paving radiography finding in asymptomatic pulmonary alveolar proteinosis Young Rak Choi, You-Jin Chang, Si Wook Kim, Kang Hyeon Choe, Ki Man Lee, and Jin-Young An Asian Cardiovascular and Thoracic Annals 2014 23 : 5 , 588-590 - Our case is a patient with biopsy proven pulmonary alveolar proteinosis. There is often geographic sparing of secondary lobules and periphery of the lung. Finaly pathology demonstrated findings consistent with pulmonary alveolar proteinosis, a rarely observed lung pathology that causes ‘crazy paving’. The purpose of this paper is to illustrate different diseases that cause this crazy-paving pattern and to correlate the radiological findings from computed tomography with the histopathological findings. Consider pulmonary alveolar proteinosis in adolescents with “crazy paving” pattern on imaging. Conflict of Interest. Department of Radiology; 2. Pulmonary alveolar proteinosis (PAP) is a rare disease of abnormal surfactant production and accumulation. Reference: 1. These findings of CT are helpful for the specific diagnosis of pulmonary alveolar proteinosis. What is the crazy paving pattern? An award-winning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, GI, cardiac and musculoskeletal diseases containing hundreds of lectures, quizzes, hand-out notes, interactive material, most commons lists and pictorial differential diagnoses . Crazy paving pattern may be seen in pulmonary alveolar proteinosis, lipoid pneumonia, pneumocystis jiroveci pneumonia, sarcoidosis, nonspecific interstitial pneumonia, silicosis, cryptogenic organizing pneumonia, adult respiratory distress syndrome, and others 1, 2. The differential diagnosis for the “crazy-paving sign” is actually quite large and goes well beyond Pulmonary Alveolar Proteinosis (PAP). Saved by Nicole Miller. "Crazy-Paving" Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview. Chest CT scan of a patient with autoimmune PAP. A chest CT showed a crazy-paving pattern… Rossi SE, et al. No source of funding or conflict of interest. Abstract. Crazy-paving Appearance at Thin-Section CT: Spectrum of Disease and Pathologic Findings. Anti-granulocyte macrophage-colony stimulating factor (anti-GM-CSF) antibody concentrations, the gold standard for diagnosis of pulmonary alveolar proteinosis, is not available in South Africa. The crazy-paving pattern is initially described as the pathognomonic sign of alveolar proteinosis. However, this pattern has subsequently been reported in a variety of pulmonary diseases and is now considered to be nonspecific. Request PDF | Crazy Paving in Pulmonary Alveolar Proteinosis | A 34-year-old man presented with dyspnea and a nonproductive cough. manifest as a crazy-paving pattern (Fig 4). Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disease characterised by alveolar accumulation of surfactant. DISCUSSION: PAP is thought to result from either overproduction of surfactant by type II pneumocytes or impaired clearance by alveolar macrophages. Authorship Nowadays this pattern is a common finding on high-resolution CT imaging, and can be seen in a number of acute and chronic diseases. PAP. 2010; 51(4):407-12 (ISSN: 1600-0455) Choi HK; Park CM; Goo JM; Lee HJ. ground glass opacities superimposed on a reticular pattern as the so-called ‘crazy paving’ pattern. 18.1. These findings are characteristic but not unique to PAP. Pulmonary alveolar proteinosis versus exogenous lipoid pneumonia showing crazy-paving pattern: Comparison of their clinical features and high-resolution CT findings. 200, P16-P17, 2019 Its name comes from its resemblance to irregular paving stones, called crazy pavings… Department of Respiratory Medicine; 3. The ground-glass attenuation reflects the low-density intraalveolar material (glycoprotein), whereas the superimposed reticular attenuation is due to infil-tration of the interstitium by inflammatory or tu-mor cells (12,13). The aforementioned HRCT findings constitute the crazy-paving pattern, which is characterized by diffuse ground-glass opacities in the lung parenchyma, together with interlobular and intralobular septal thickening. Although this pattern is suggestive of the diagnosis of pulmonary alveolar proteinosis, this pattern can be seen in several air-space and interstitial diseases . • Delayed diagnosis due to infectious mimickers is common in the young age group. A chest CT showed a crazy-paving pattern. She was diagnosed with autoimmune pulmonary alveolar proteinosis based on bronchoalveolar lavage findings and the presence of serum anti-granulocyte macrophage colony-stimulating factor antibodies. It was first described in the late 1980s in patients with pulmonary alveolar proteinosis, but has now been described in association with at least 15 pulmonary diseases. A bronchoscopic alveolar lavage revealed alveolar proteinaceous material compatible with the diag-nosis pulmonary alveolar proteinosis (PAP). Fig. Pulmonary alveolar proteinosis (PAP) is an example of these processes with its typical radiological findings including ground glass opacities, parenchymal consolidation, and reticuloseptal reticulations leading to a non‐specific but characteristic crazy paving pattern. It is typically … Chest CT Scan. REVIEW: PULMONARY ALVEOLAR PROTEINOSIS c EUROPEAN RESPIRATORY REVIEW VOLUME 20 NUMBER 120 99. alveolar accumulation. This pattern is considered to be caused by pulmonary alveolar proteinosis, but its association with various diseases is unclear. CASE PRESENTATION A 32-year-old Caucasian man without a significant medical history pre-sented with a two-month history of progressively worsening dyspnea on exertion. sign of alveolar proteinosis. It may result from mutations in surfactant proteins or granulocyte macrophage-colony stimulating factor (GM-CSF) receptor genes, it may be secondary to toxic inhalation or haematological disorders, or it may be auto-immune, with anti-GM-CSF antibodies blocking … The “crazy paving” pattern 12 is described at HRCT of the lungs . Both processes lead to the accumulation of surfactant-rich material within alveoli i.e. 17. Crazy-paving. Pulmonary alveolar proteinosis versus exogenous lipoid pneumonia showing crazy-paving pattern: Comparison of their clinical features and high-resolution CT fi ndings H EI KYUNG C HOI C HANG MIN PARK, JIN MO G OO& H YUN JU L EE Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, … Very rarely, it also displays a “crazy paving” pattern (also described as a “paving stone,” “flagstone,” or “slabstone” pattern), which is rarer still in discrete bilateral nodules. Radiographics 2003;23:1509. Although the majority of patients with PAP will have a CT consistent with the crazy paving pattern, this radiographic pattern is by no means specific to PAP. Background: Although pulmonary alveolar proteinosis (PAP) and exogenous lipoid pneumonia (ELP) require different treatment strategies, both manifest as a crazy-paving pattern on CT and often have similar clinical manifestations and radiologic features. INTRODUCTION: A ‘crazy-paving’ appearance of the lungs on computed tomography scanning of the chest was first described nearly 20 years ago in patients with pulmonary alveolar proteinosis, and was thought to be characteristic of this condition. And the presence of serum anti-granulocyte macrophage colony-stimulating factor antibodies by alveolar accumulation surfactant... Finding on high-resolution CT findings as the so-called ‘ crazy paving pattern is initially described the. And periphery of the lung tissue and may reveal a “ crazy ”. 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