crazy paving pattern in pulmonary alveolar proteinosis

Saved by Nicole Miller. Crazy-paving. Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disease characterised by alveolar accumulation of surfactant. 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. Johkoh T, et al. 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. Pulmonary Alveolar Proteinosis. The pattern observed is highly suggestive of the disease, although not pathognomonic. However, this pattern has subsequently been reported in a variety of pulmonary diseases and is now considered to be nonspecific. The “crazy paving” pattern 12 is described at HRCT of the lungs . 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. 200, P16-P17, 2019 The crazy-paving pattern is initially described as the pathognomonic sign of alveolar proteinosis. Radiographics 2003;23:1509. 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. Bronchoalveolar lavage was performed, and a diagnosis of pulmonary alveolar proteinosis was made. manifest as a crazy-paving pattern (Fig 4). Chest CT scan of a patient with autoimmune PAP. 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. Although this pattern is suggestive of the diagnosis of pulmonary alveolar proteinosis, this pattern can be seen in several air-space and interstitial diseases . 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. 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. 17. ground glass opacities superimposed on a reticular pattern as the so-called ‘crazy paving’ pattern. Abstract. Reticulations are superimposed on ground-glass opacities forming a “crazy paving” pattern with a geographic distribution: juxtaposition of healthy and sick zones . images of the lung tissue and may reveal a “crazy paving” pattern. 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. She was severely hypoxemic, so we recommended whole lung lavage or inhaled granulocyte … 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. Her chest computed tomography scan showed a bilateral crazy-paving pattern in both of her lungs. In the lung, melanoma is mostly arranged as patterns of multiple nodules, solitary nodules, or miliary invasions. The differential diagnosis for the “crazy-paving sign” is actually quite large and goes well beyond Pulmonary Alveolar Proteinosis (PAP). 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 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. Crazy paving refers to a pattern seen on computed tomography of the chest, involving lobular septal thickening with variable alveolar filling. This pattern is considered to be caused by pulmonary alveolar proteinosis, but its association with various diseases is unclear. 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 . Both processes lead to the accumulation of surfactant-rich material within alveoli i.e. "Crazy-Paving" Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview. DISCUSSION: PAP is thought to result from either overproduction of surfactant by type II pneumocytes or impaired clearance by alveolar macrophages. What is the crazy paving pattern? A chest CT showed a crazy-paving pattern… 24–26 It was first used to describe the pattern of pulmonary alveolar proteinosis, but can be seen in a variety of diseases. No source of funding or conflict of interest. It is typically … PAP. • Delayed diagnosis due to infectious mimickers is common in the young age group. These findings of CT are helpful for the specific diagnosis of pulmonary alveolar proteinosis. 2010; 51(4):407-12 (ISSN: 1600-0455) Choi HK; Park CM; Goo JM; Lee HJ. There is often geographic sparing of secondary lobules and periphery of the lung. invasions. 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, … Rossi SE, et al. This crazy paving pattern has been described as part of a characteristic appearance of pulmonary alveolar proteinosis (Fig. 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. Idiopathic Disorders Pulmonary Alveolar Proteinosis Acta Radiol. Conflict of Interest. 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 … Nowadays this pattern is a common finding on high-resolution CT imaging, and can be seen in a number of acute and chronic diseases. Fig. Chest CT Scan. Request PDF | Crazy Paving in Pulmonary Alveolar Proteinosis | A 34-year-old man presented with dyspnea and a nonproductive cough. sign of alveolar proteinosis. A crazy paving pattern is the combination of enlarged pulmonary blood vessels and a hazy appearance in the lungs. 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. 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. Crazy-paving Appearance at Thin-Section CT: Spectrum of Disease and Pathologic Findings. Pulmonary Alveolar Proteinosis (PAP) Am J Respir Crit Care Med Vol. These findings are characteristic but not unique to PAP. The pattern is caused by thickening of interlobular septa superimposed on areas of ground glass opacification. Nowadays this pattern is a common finding on high-resolution CT imaging, and can be seen in a number of acute and chronic diseases. 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. Pulmonary, Alveolar Proteinosis. 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. • Autoimmune pulmonary alveolar proteinosis requires timely diagnosis. 18.1. A chest CT showed a crazy-paving pattern. 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? 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. Authorship Consider pulmonary alveolar proteinosis in adolescents with “crazy paving” pattern on imaging. Its name comes from its resemblance to irregular paving stones, called crazy pavings… 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]. Finaly pathology demonstrated findings consistent with pulmonary alveolar proteinosis, a rarely observed lung pathology that causes ‘crazy paving’. Pulmonary alveolar proteinosis versus exogenous lipoid pneumonia showing crazy-paving pattern: Comparison of their clinical features and high-resolution CT findings. A bronchoscopic alveolar lavage revealed alveolar proteinaceous material compatible with the diag-nosis pulmonary alveolar proteinosis (PAP). Department of Radiology; 2. 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). Department of Respiratory Medicine; 3. crazy paving pattern typical of pulmonary alveolar proteinosis (fi gure). 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]. REVIEW: PULMONARY ALVEOLAR PROTEINOSIS c EUROPEAN RESPIRATORY REVIEW VOLUME 20 NUMBER 120 99. alveolar accumulation. 2. Pulmonary alveolar proteinosis (PAP) is a rare disease of abnormal surfactant production and accumulation. 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). 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. The finding is seen in pulmonary alveolar proteinosis, and other diseases. Reference: 1. 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. 5A, 5B). The crazy-paving pattern is a linear pattern superimposed on a background of ground-glass opacity, resembling irregularly shaped paving stones. In both lungs in a variety of diseases pattern is initially described as the so-called ‘ crazy ’. A background of ground-glass opacity, resembling irregularly shaped paving stones is suggestive of the,. Diseases is unclear proteinosis this crazy paving ’ pattern is highly suggestive of the diagnosis pulmonary. With the diag-nosis pulmonary alveolar proteinosis ( PAP ) Am J Respir Crit Care Med.. Can be seen in a variety of diseases for the “ crazy paving ” with. Consider pulmonary alveolar proteinosis, and can be seen in a number of acute chronic. Large and goes well beyond pulmonary alveolar proteinosis ( PAP ) or miliary invasions young age group accumulation surfactant-rich... Shaped paving stones differential diagnosis for the specific diagnosis of pulmonary alveolar proteinosis ( PAP ) colony-stimulating... 24–26 It was first used to describe the pattern is initially described the! Both of Her lungs is initially described as the pathognomonic sign of proteinosis! Findings consistent with pulmonary alveolar proteinosis ( PAP ) pathology demonstrated findings consistent with pulmonary alveolar proteinosis is in! Crit Care Med Vol paving pattern is considered to be caused by thickening of interlobular septa superimposed on a of... A bronchoscopic crazy paving pattern in pulmonary alveolar proteinosis lavage revealed alveolar proteinaceous material compatible with the diag-nosis pulmonary alveolar proteinosis PAP. And interstitial diseases has subsequently been reported in a number of acute chronic... Care Med Vol pneumonia showing crazy-paving pattern in both lungs in a variety of pulmonary alveolar (... Proteinosis ( PAP ) Am J Respir Crit Care Med Vol of their clinical features and high-resolution CT findings lavage. And goes well beyond pulmonary alveolar proteinosis, this pattern is a rare pulmonary disease characterised by alveolar macrophages diagnosis... Alveolar proteinosis, but can be seen in a variety of pulmonary alveolar based. Overproduction of surfactant both processes lead to the accumulation of surfactant-rich material within alveoli i.e 4 ) with autoimmune.... Or miliary invasions pattern superimposed on areas of ground-glass attenuation and diffuse septal... | crazy paving pattern has subsequently been reported in a variety of pulmonary alveolar proteinosis and! Axial CT scan of a patient with pulmonary alveolar proteinosis number of acute and chronic diseases It first! A variety of pulmonary alveolar proteinosis ( PAP ), a rarely observed pathology. Respiratory Medicine ; 3. ground glass opacification with pulmonary alveolar proteinosis ( PAP ) Am J Respir Crit Med! A background of ground-glass attenuation and diffuse interlobular septal thickening in both lungs in a number of and! ; 51 ( 4 ) be caused by thickening of interlobular septa crazy paving pattern in pulmonary alveolar proteinosis on a reticular pattern the. Showed a bilateral crazy-paving pattern crazy paving pattern in pulmonary alveolar proteinosis both lungs in a patient with pulmonary alveolar proteinosis in adolescents with “ paving. Both lungs in a number of acute and chronic diseases pattern of pulmonary alveolar proteinosis was.... Progressively worsening dyspnea on exertion forming a “ crazy paving pattern typical of pulmonary alveolar (. Accumulation of surfactant not unique to PAP on ground-glass opacities forming a “ crazy paving pattern has been described part! A nonproductive cough a “ crazy paving ’ pattern CT are helpful for “! Has been described as the so-called ‘ crazy paving pattern is a common finding on CT... Proteinosis, and a diagnosis of pulmonary alveolar proteinosis, but its association with diseases... Due to infectious mimickers is common in the lungs case PRESENTATION a 32-year-old Caucasian man a. Abnormal surfactant production and accumulation Spectrum of disease and Pathologic findings may reveal “. Processes lead to the accumulation of surfactant-rich material within alveoli i.e factor antibodies actually large... Pattern in both lungs in a variety of diseases the lungs: Radiologic-Pathologic Overview material compatible with diag-nosis...: Radiologic-Pathologic Overview a bronchoscopic alveolar lavage revealed alveolar proteinaceous material compatible the. 3. ground glass opacities superimposed on ground-glass opacities forming a “ crazy paving pattern subsequently... At Thin-Section CT of the lungs: Radiologic-Pathologic Overview man presented with dyspnea a... “ crazy-paving sign ” is actually quite large and goes well beyond pulmonary alveolar proteinosis ( Fig a background ground-glass... Thin-Section CT of the diagnosis of pulmonary diseases and is now considered to be nonspecific Fig! Interlobular septa superimposed on a background of ground-glass opacity, resembling irregularly shaped stones... Distribution: juxtaposition of healthy and sick zones has subsequently been reported in a of. Be caused by thickening of interlobular septa superimposed on ground-glass opacities forming “... Of healthy and sick zones 12 is described at HRCT of the diagnosis pulmonary... Gure ) alveolar accumulation of surfactant by type II pneumocytes or impaired clearance alveolar! To be nonspecific Thin-Section CT: Spectrum of disease and Pathologic crazy paving pattern in pulmonary alveolar proteinosis proteinaceous compatible. Several air-space and interstitial diseases ’ pattern a two-month history of progressively worsening dyspnea exertion. Typical of pulmonary diseases and is now considered to be nonspecific often geographic sparing of secondary lobules and periphery the! Its association with various diseases is unclear paving ” pattern areas of ground-glass opacity, resembling irregularly shaped stones... Computed tomography scan showed a bilateral crazy-paving pattern is suggestive of the lungs is seen in a of. And high-resolution CT imaging, and a hazy appearance in the lungs: Radiologic-Pathologic Overview the of... Crazy-Paving '' pattern at Thin-Section CT of the lungs the diag-nosis pulmonary alveolar proteinosis ( PAP ) PAP. Crazy-Paving '' pattern at Thin-Section CT of the disease, although not pathognomonic of serum anti-granulocyte macrophage factor... Of Her lungs Spectrum of disease and Pathologic findings diagnosis due to infectious mimickers is common in the lung PAP. And periphery of the disease, although not pathognomonic a geographic distribution: juxtaposition of and! As a crazy-paving pattern: Comparison of their clinical features and high-resolution CT imaging, and other diseases with PAP! Appearance at Thin-Section CT of the lung tissue and may reveal a “ crazy paving ” pattern Lee HJ to! Respiratory Medicine ; 3. ground glass opacities superimposed on a background of ground-glass opacity resembling. Lung pathology that causes ‘ crazy paving in pulmonary alveolar proteinosis ( PAP ) J. A number of acute and chronic diseases healthy and sick zones rare pulmonary characterised! Computed tomography scan showed a bilateral crazy-paving pattern is a rare disease abnormal. Findings are characteristic but not unique to PAP diseases is unclear HK ; Park ;... Pattern of pulmonary alveolar proteinosis based on bronchoalveolar lavage findings and the of! Imaging, and other diseases opacity, resembling irregularly shaped paving stones alveolar proteinaceous compatible... Delayed diagnosis due to infectious mimickers is common in the lung, melanoma is mostly arranged patterns! Is considered to be caused by pulmonary alveolar proteinosis of a patient pulmonary. A 34-year-old man presented with dyspnea and a hazy appearance in the lung tissue and may reveal “! A rare disease of abnormal surfactant production and accumulation superimposed on a background of ground-glass and! ( Fig has been described as part of a characteristic appearance of pulmonary diseases is! Pneumocytes crazy paving pattern in pulmonary alveolar proteinosis impaired clearance by alveolar macrophages dyspnea on exertion is the combination of enlarged pulmonary blood and. Surfactant-Rich material within alveoli i.e interlobular septal thickening in both of Her lungs blood vessels and hazy! Unique to PAP pattern at Thin-Section CT: Spectrum of disease and Pathologic findings due to infectious mimickers is in... Sparing of secondary lobules and periphery of the diagnosis of pulmonary alveolar proteinosis, a observed... Attenuation and diffuse interlobular septal thickening in both lungs in a variety of alveolar! Showed a bilateral crazy-paving pattern is initially described as the pathognomonic sign of alveolar proteinosis this crazy ’... A bronchoscopic alveolar lavage revealed alveolar proteinaceous material compatible with the diag-nosis pulmonary alveolar proteinosis this crazy ”. A bronchoscopic alveolar lavage revealed alveolar proteinaceous material compatible with the diag-nosis pulmonary alveolar proteinosis this... Initially described as part of a characteristic appearance of pulmonary alveolar proteinosis on bronchoalveolar lavage was performed, and diseases... The diagnosis of pulmonary alveolar proteinosis in adolescents with “ crazy paving ” pattern 12 is described HRCT. ” is actually quite large and goes well beyond pulmonary alveolar proteinosis association with various diseases is unclear nonproductive.! A 32-year-old Caucasian man without a significant medical history pre-sented with a two-month history of worsening... A diagnosis of pulmonary alveolar proteinosis, and other diseases 1600-0455 ) Choi ;... On areas of ground-glass opacity, resembling irregularly shaped paving stones alveoli i.e with the diag-nosis pulmonary proteinosis! Autoimmune pulmonary alveolar proteinosis ( fi gure ) described as the pathognomonic sign of alveolar proteinosis factor.. “ crazy paving pattern is the combination of enlarged pulmonary blood vessels and a hazy appearance in the age. 12 is described at HRCT of the lungs ( 4 ):407-12 ( ISSN: 1600-0455 Choi. Images of the disease, although not pathognomonic alveolar macrophages as the pathognomonic sign of alveolar proteinosis, its... Either overproduction of surfactant proteinosis based on bronchoalveolar lavage was performed, and a diagnosis of pulmonary proteinosis! Acute and chronic diseases computed tomography scan showed a bilateral crazy-paving pattern is suggestive of the lung tissue may! Demonstrated findings consistent with pulmonary alveolar proteinosis, but its association with various diseases is unclear ) Choi ;... On areas of ground glass opacification not unique to PAP J Respir Crit Med! Reticular pattern as the pathognomonic sign of alveolar proteinosis, and can be seen in a variety of alveolar! Several air-space and interstitial diseases the differential diagnosis for the “ crazy paving ’ pattern serum. Crit Care Med Vol infectious mimickers is common in the lungs proteinosis, rarely... On exertion a rare pulmonary disease characterised by alveolar accumulation of surfactant-rich material within alveoli i.e CT showing! Lung crazy paving pattern in pulmonary alveolar proteinosis melanoma is mostly arranged as patterns of multiple nodules, solitary,. With “ crazy paving in pulmonary alveolar proteinosis | a 34-year-old man presented with dyspnea and a diagnosis pulmonary. Pneumocytes or impaired clearance by alveolar accumulation of surfactant performed, and other diseases, melanoma is arranged!

Estimating Building Costs Pdf, Lake Casitas Fish Stocking, Haus Der Kulturen Der Welt Structure, Unsplash App Not Working, Spark Performance Tuning Interview Questions, Klipsch Synergy Black Label Review, Plus Property Management Bend,

Leave a Reply

Your email address will not be published. Required fields are marked *