Crazy-paving appearance at thin-section CT: spectrum of disease and pathologic findings

To determine the spectrum of disease associated with a fine reticular pattern superimposed on areas of ground-glass opacity (i.e., "crazy-paving" appearance) at thin-section computed tomography (CT) and to determine the underlying pathologic features.

In the in vivo study, the cases of 46 patients (21 male, 25 female; age range, 13-82 years) were retrospectively reviewed, with special attention paid to the size and extent of the reticular network. In the in vitro study, the thin-section CT findings in 20 inflated and fixed lungs were precisely correlated with the gross appearance, contact radiograph findings, stereomicroscopic views, and histologic findings.

In the in vivo study, 15 different diseases were identified, including alveolar proteinosis, adult respiratory distress syndrome, acute interstitial pneumonia, diffuse alveolar damage superimposed on usual interstitial pneumonia, and drug-induced pneumonitis. In the in vitro study, the fine networks at pathologic analysis were due to an alveolar filling process (n = 10), an interstitial fibrotic process (n = 7), or a combination of interstitial and intraalveolar processes (n = 3). Twelve (60%) cases did not have thickening of the interlobular septa within the areas of the crazy-paving appearance.

The crazy-paving appearance is a nonspecific finding seen in a variety of interstitial and airspace lung diseases.