"Crazy-paving" pattern at thin-section CT of the lungs: radiologic-pathologic overview

Area of Science:

• Radiology
• Pulmonary Medicine
• Pathology

Background:

• The crazy-paving pattern is a frequent observation in thin-section computed tomography (CT) of the lungs.
• This pattern is characterized by ground-glass attenuation with superimposed interlobular septal and intralobular linear thickening.

Purpose of the Study:

• To review the diverse etiologies of the crazy-paving pattern observed in lung CT.
• To highlight the diagnostic utility of this pattern and associated radiological findings.

Main Methods:

• Literature review of studies describing the crazy-paving pattern on CT.
• Analysis of the differential diagnoses associated with this imaging finding.
• Correlation of radiological features with clinical presentation and patient history.

Main Results:

• The crazy-paving pattern is associated with a wide spectrum of conditions, including infectious (e.g., Pneumocystis carinii pneumonia), neoplastic (e.g., bronchioloalveolar carcinoma), and inflammatory disorders (e.g., sarcoidosis, interstitial pneumonia).
• Specific causes include pulmonary alveolar proteinosis, organizing pneumonia, lipoid pneumonia, adult respiratory distress syndrome, and pulmonary hemorrhage syndromes.
• While often indistinguishable solely on imaging, location, additional findings, and clinical context can suggest specific diagnoses.

Conclusions:

• The crazy-paving pattern on lung CT is a nonspecific finding with numerous potential causes.
• Understanding the differential diagnosis is crucial for accurate interpretation and avoiding diagnostic errors.
• Integrating CT findings with clinical information is essential for optimal patient management.