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"Crazy-Paving" Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview¹

¹ From the Departments of Radiology (S.E.R., M.V.) and Pathology (T.C.), Centro de Diagnostico Dr Enrique Rossi, Arenales 2777, Buenos Aires 1425, Argentina; the Department of Radiology, University of Texas M.D. Anderson Cancer Center, Houston (J.J.E.); the Department of Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Spain (T.F.); and the Department of Radiology, Duke University Medical Center, Durham, NC (H.P.M.). Recipient of a Cum Laude award and an Excellence in Design award for an education exhibit at the 2002 RSNA scientific assembly. Received April 9, 2003; revision requested May 12 and received July 24; accepted July 25. Address correspondence to S.E.R. (e-mail: santirossi@cdrossi.com).

The "crazy-paving" pattern is a common finding at thin-section computed tomography (CT) of the lungs. It consists of scattered or diffuse ground-glass attenuation with superimposed interlobular septal thickening and intralobular lines. This finding has a variety of causes, including infectious, neoplastic, idiopathic, inhalational, and sanguineous disorders. Specific disorders that can cause the crazy-paving pattern include Pneumocystis carinii pneumonia, mucinous bronchioloalveolar carcinoma, pulmonary alveolar proteinosis, sarcoidosis, nonspecific interstitial pneumonia, organizing pneumonia, exogenous lipoid pneumonia, adult respiratory distress syndrome, and pulmonary hemorrhage syndromes. Knowledge of the many causes of this pattern can be useful in preventing diagnostic errors. In addition, although the causes of this pattern are frequently indistinguishable at radiologic evaluation, differences in the location of the characteristic attenuation in the lungs, as well as the presence of additional radiologic findings, the patient’s history, and the clinical presentation, can often be useful in suggesting the appropriate diagnosis.

© RSNA, 2003

Index Terms: Bronchiolitis obliterans organizing pneumonia, 60.795 • Lung, ground-glass opacification, 60.12118 • Lung, hemorrhage, 60.60 Lung, infection, 60.2075, 60.21 • Lung neoplasms, diagnosis, 60.3216 • Pneumocystis carinii, 60.2075 • Pneumonia, 60.21, 60.253, 60.795 • Pneumonia, lipoid, 60.253 • Pneumonia, nonspecific interstitial and fibrosis, 60.795 • Proteinosis, pulmonary alveolar, 60.791 • Respiratory distress syndrome, adult (ARDS), 60.413 • Sarcoidosis, 60.222

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