Study on the crazy-paving pattern：83 cases of thin-section CT findings / 中国医学装备

Objective:The purpose of this paper is to illustrate different diseases that cause this crazy-paving pattern and to correlate the thin-section CT findings with the histopathological findings. Methods: A retrospective review of the medical records of our radiological computed tomography database was performed from January 2010 until December 2012,searching for patients reported to have a crazy-paving pattern on a thin-section CT of the chest. In total, 83 patients with a crazy-paving pattern were retained and reviewed. Results:The crazy-paving pattern consists of interlobular septal and intralobular interstitial thickening superimposed on an area of ground-glass attenuation on thin-section CT scans. We identified 83 cases that presented with the crazy-paving pattern, inclould infection(bacterial infection n=6,viral infection n=16,fungal infection n=1,and mixed infection n=12); ARDS n=4; acute pulmonary oedema n=3; interstitial lung disease (UIP, NSIP) n=18; adenocarcinomas n=3; lymphangitis carcinomatosis n=3;lymphoma pulmonary infiltration n=2;radiation pneumonitis n=5;sarcoidosis n=1;alveolar proteinosis n=4;alveolar hemorrhage n=4; lipid pneumonia n=1. Conclusion: The crazy-paving pattern on thin-section CT is a non-specific signs, can be seen in infections, tumor, as well as some cryptogenetic diseases. Nevertheless, familiar with these common diseases, allows us to narrow the differential diagnosis, even prompted the diagnosis of certain diseases in the appropriate clinical setting.

Aspectos tomográficos e anatomopatológicos do padrão de pavimentação em mosaico / Tomographic and pathological findings of crazy-paving pattern

OBJETIVO: Relatar os aspectos na tomografia computadorizada de alta resolução de diversas doenças que cursam com o padrão tomográfico de "pavimentação em mosaico". MATERIAIS E MÉTODOS: Foram estudados sete pacientes, com diagnósticos de proteinose alveolar, carcinoma bronquíolo-alveolar, pneumonia lipídica e pneumocistose, e é discutida a correlação dos aspectos tomográficos com os achados anatomopatológicos. RESULTADOS: Nos casos de pneumocistose, os espaços alveolares estavam cheios de material espumoso, no qual eram encontrados parasitas de permeio a surfactante, fibrina e restos celulares. Nos casos de carcinoma bronquíolo-alveolar, os septos estavam espessados por fibrose ou por linfangite associada, com células tumorais revestindo internamente as paredes alveolares, e produção de muco. No paciente com proteinose alveolar foram observados septos espessados por edema, com enchimento alveolar determinado por material lipoproteico. No paciente com aspiração de óleo mineral, os achados histopatológicos foram de espessamento dos septos alveolares determinado por proliferação celular, observando-se vacúolos de gordura no interior dos septos alveolares. CONCLUSÃO: O padrão de pavimentação em mosaico oferece um amplo diagnóstico diferencial, necessitando ser avaliado em conjunto com os dados clínicos.

OBJECTIVE: To describe high-resolution computed tomography findings in several diseases that run their course with the "crazy-paving" pattern. MATERIALS AND METHODS: The present study has evaluated seven patients with diagnoses of alveolar proteinosis, bronchioloalveolar carcinoma, lipoid pneumonia and pneumocystosis, correlating tomographic and pathological findings. RESULTS: In the cases of pneumocystosis, the alveolar spaces were filled with foamy material where parasitic organisms intermingled with surfactants, fibrin and cell debris were observed. In the cases of bronchioloalveolar carcinoma, the septa were thickened by associated fibrosis or lymphangitis, with the alveolar walls internally lined with tumor cells, and production of mucus. In the patient with alveolar proteinosis, the septa were thickened by edema, with alveolar filling determined by lipoprotein. In the patient with mineral oil aspiration, the histopathological findings included alveolar septa thickening caused by cell proliferation, with presence of fat vacuoles in alveolar septa. CONCLUSION: The crazy-paving pattern offers a wide range of differential diagnoses and must be evaluated in conjunction with clinical findings.

"Crazy-Paving" Patterns on High-Resolution CT Scans in Patients with Pulmonary Complications after Hematopoietic Stem Cell Transplantation

OBJECTIVE: To describe the pulmonary complications following hematopoietic stem cell transplantation (HSCT) that can present with a "crazy-paving" pattern in high-resolution CT scans. MATERIALS AND METHODS: Retrospective review of medical records from 2,537 patients who underwent HSCT. The "crazy-paving" pattern consists of interlobular and intralobular septal thickening superimposed on an area of ground-glass attenuation on high-resolution CT scans. The CT scans were retrospectively reviewed by two radiologists, who reached final decisions by consensus. RESULTS: We identified 10 cases (2.02%), seven male and three female, with pulmonary complications following HSCT that presented with the "crazy-paving" pattern. Seven (70%) patients had infectious pneumonia (adenovirus, herpes simplex, influenza virus, cytomegalovirus, respiratory syncytial virus, and toxoplasmosis), and three patients presented with non-infectious complications (idiopathic pneumonia syndrome and acute pulmonary edema). The "crazy-paving" pattern was bilateral in all cases, with diffuse distribution in nine patients (90%), predominantly in the middle and inferior lung regions in seven patients (70%), and involving the anterior and posterior regions of the lungs in nine patients (90%). CONCLUSION: The "crazy-paving" pattern is rare in HSCT recipients with pulmonary complications and is associated with infectious complications more commonly than non-infectious conditions.