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Secondary pulmonary lobule crazy paving sign

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Secondary pulmonary lobule
crazy paving sign

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Secondary pulmonary lobule crazy paving sign

  1. 1. Dr MazenQusaibatyMD, DISHead Pulmonary and Internist Department Ibnalnafisse HospitalMinistry of Syrian healthEmail: Qusaibaty@gmail.com<br />Secondary pulmonary lobule<br />Crazy paving sign<br />
  2. 2. Topic Outline<br />Secondary pulmonary lobule<br />Crazy paving sign<br />2<br />
  3. 3. Secondary pulmonary lobule<br />3<br />
  4. 4. 4<br />
  5. 5. Secondary pulmonary lobule<br />Unit of lung (0.5-3 cm)<br />Irregularly polyhedral<br />5<br />
  6. 6. Secondary pulmonary lobule<br />A group of terminal bronchioles<br />6<br />
  7. 7. Secondary pulmonary lobule<br />Accompanyingpulmonary arterioles<br />7<br />
  8. 8. Secondary pulmonary lobule<br />Surrounded by lymph vessels<br />8<br />
  9. 9. Secondary pulmonary lobule<br />Demarcated by “interlobular septa”<br />9<br />
  10. 10. Secondary pulmonary lobule<br />Pulmonary veins<br />10<br />
  11. 11. Secondary pulmonary lobule<br />Pulmonary lymphatics<br />11<br />
  12. 12. 12<br />Connective Tissue Stroma<br />
  13. 13. 13<br />Quiz<br />
  14. 14. 14<br />Quiz<br />
  15. 15. 15<br />Quiz<br />
  16. 16. 16<br />Quiz<br />
  17. 17. 17<br />Quiz<br />
  18. 18. 18<br />Quiz<br />
  19. 19. 19<br />Quiz<br />
  20. 20. Crazy paving sign<br />
  21. 21. Crazy paving sign<br />Refers to the combination of ground glass attenuation superimposed on a network of interlobular septal thickening giving it an appearance of a surface paved with slabs of differing shapes<br />21<br />
  22. 22. 22<br />Crazy paving sign<br />Crazy Paving is a combination of ground glass opacity with superimposed net of septal thickening <br />
  23. 23. Crazy paving sign<br />Alveolar proteinosis<br />23<br />
  24. 24. Crazy paving sign<br />Thin-section CT scan targeted to the left upper lobe in a 41-year-old man with alveolar proteinosis<br />24<br />
  25. 25. 25<br />Crazy Paving sign<br />
  26. 26. 26<br />Crazy Paving<br />
  27. 27. 27<br />Crazy Paving sign<br />
  28. 28. 28<br />Crazy Paving sign<br />
  29. 29. 29<br />Crazy Paving sign<br />
  30. 30. 30<br />Crazy Paving sign<br />
  31. 31. 31<br />Crazy Paving sign<br />
  32. 32. 32<br />Crazy Paving sign<br />
  33. 33.  Causes of the crazy-paving pattern<br />33<br />http://radiographics.rsna.org/content/23/6/1509/F2.expansion.html<br />
  34. 34. Case 01 /Crazy Paving sign<br />Thin-section CT scan of right upper lobe<br />34<br />
  35. 35. Case 01 / Crazy Paving sign<br />A fine reticular pattern superimposed on a background of ground-glass opacity—that is, the crazy-paving pattern.<br />35<br />
  36. 36. Case 01 / Crazy Paving sign<br />Fluid within the major fissure(arrowheads)<br />36<br />
  37. 37. Case 01 / Crazy Paving sign<br />A 32-year-old man with ARDS <br />37<br />
  38. 38. Case 02 / Thin-section CT scan of right lower lobe<br />The crazy-paving pattern is present in the right lower lobe, particularly in the region circumscribed by the arrowheads<br />38<br />
  39. 39. Case 02 / Crazy Paving sign<br />The minimum and maximum sizes of each frame of the network are 2 and 6 mm, respectively.<br />39<br />
  40. 40. Case 02 / Crazy Paving sign<br />A 65-year-old woman with chronic eosinophilic pneumonia<br />40<br />
  41. 41. Case 03 / Thin-section CT scan of the left lower lobe <br />Crazy-paving appearance, which is best seen in the region circumscribed by the arrows.<br />41<br />
  42. 42. Case 03 / Postmortem findings in a 41-year-old woman <br />Alveolar Hemorrhage<br />42<br />
  43. 43. Case 04 / High-resolution CT scan <br />Areas of ground-glass attenuation with intralobular lines<br />43<br /> http://radiographics.rsna.org/content/23/6/1509/F3.expansion.html<br />
  44. 44. P carinii pneumonia in a 32-year-old man with acquired immunodeficiency syndrome.<br />44<br /> http://radiographics.rsna.org/content/23/6/1509/F3.expansion.html<br />
  45. 45. Case 04 / Photomicrograph (original magnification, ×400; Grocott stain) of a specimen obtained with bronchoalveolar lavage <br />shows alveolar exudates that contain cystic forms of P carinii (arrows)<br />45<br /> http://radiographics.rsna.org/content/23/6/1509/F4.expansion.html<br />
  46. 46. Case 05 / Diffuse mucinous bronchioloalveolar carcinoma in a 78-year-old man / High-resolution CT scan<br />shows a bilateral crazy-paving pattern and centrilobular nodules.<br />46<br /> http://radiographics.rsna.org/content/23/6/1509/F5.expansion.html<br />
  47. 47. Case 06 / Sarcoidosis in a 25-year-old asymptomatic man<br />High-resolution CT scan<br />Shows scattered bilateral areas of ground-glass attenuation associated with inter- and intralobular lines.<br />47<br /> http://radiographics.rsna.org/content/23/6/1509/F11.expansion.html<br />
  48. 48. Case 07<br />Methotrexate-induced NSIP in a 41-year-old woman with rheumatoid arthritis who presented with dyspnea and decreased diffusing capacity of the lungs for carbon monoxide (DLCO).<br />48<br /> http://radiographics.rsna.org/content/23/6/1509/F12.expansion.html<br />
  49. 49. Case 07 / Photomicrograph (original magnification, ×400; hematoxylin-eosin stain) of a specimen from lung biopsy <br />Shows patchy interstitial fibrosis<br />Expansion of the interstitium by:<br /><ul><li>Chronic inflammatory infiltrates
  50. 50. Reactive hyperplastic type II pneumonocytes(arrow)</li></ul>49<br /> http://radiographics.rsna.org/content/23/6/1509/F13.expansion.html<br />
  51. 51. Case 07 / Photomicrograph (original magnification, ×400; hematoxylin-eosin stain) of a specimen from lung biopsy <br />Findings consistent with NSIP induced by the pulmonary toxic effects of Methotrexate.<br />50<br /> http://radiographics.rsna.org/content/23/6/1509/F13.expansion.html<br />
  52. 52. Case 08 / Amiodarone-induced NSIP in an 88-year-old man with severe dyspnea<br />High-resolution CT scan shows bilateral diffuse ground-glass attenuation and inter- and intralobular lines.<br />Note the traction bronchiectasis.<br />51<br /> http://radiographics.rsna.org/content/23/6/1509/F14.expansion.html<br />
  53. 53. Case 09<br />Bleomycin induced organizing pneumonia in a 44-year-old woman with Hodgkin lymphoma who presented with:<br />A nonproductive cough<br />Dyspnea<br />Decreased DLCO<br />52<br />
  54. 54. Case 09 / High-resolution CT/ Bleomycin inducedBOOP <br />Crazy-paving sign<br />53<br /> http://radiographics.rsna.org/content/23/6/1509/F17.expansion.html<br />
  55. 55. Case 09 / High-resolution CT/ Bleomycin inducedBOOP <br />The diagnosis of was confirmed with transthoracic biopsy<br />54<br /> http://radiographics.rsna.org/content/23/6/1509/F17.expansion.html<br />
  56. 56. Case 09 / High-resolution CT/ Bleomycin inducedBOOP <br />There was improvement in the symptoms and radiologic findings after:<br /><ul><li>Discontinuation of the Bleomycin therapy
  57. 57. Initiation of corticosteroid therapy</li></ul>55<br /> http://radiographics.rsna.org/content/23/6/1509/F17.expansion.html<br />
  58. 58. Case 10<br />Lipoid pneumonia in a 64-year-old woman with a 20-year history of scleroderma who presented:<br />Progressive dyspnea<br />Dry cough<br />56<br />
  59. 59. Case 10 /High-resolution CT scan/ Lipoid pneumonia<br />Shows Crazy-paving sign(arrow) <br />57<br /> http://radiographics.rsna.org/content/23/6/1509/F19.expansion.html<br />
  60. 60. Case 10 /High-resolution CT scan/ Lipoid pneumonia<br />The results of bronchoalveolar lavage and transbronchial biopsy were nondiagnostic<br />58<br /> http://radiographics.rsna.org/content/23/6/1509/F19.expansion.html<br />
  61. 61. Case 10 / Photomicrograph (original magnification, ×250; hematoxylin-eosin stain) of a specimen from open lung biopsy <br />shows numerous lipid-laden macrophages that fill and distend the alveoli (arrow) and interstitium.<br />59<br /> http://radiographics.rsna.org/content/23/6/1509/F20.expansion.html<br />
  62. 62. Case 11 / Posteroanterior chest radiograph <br />Shows a centrally located mass adjacent to an area of diffuse ground-glass opacity in the right upper lobe.<br />Note the air trapping in the lung base.<br />60<br /> http://radiographics.rsna.org/content/23/6/1509/F24.expansion.html<br />
  63. 63. Case 11 / Posteroanterior chest radiograph <br />CT scan shows typical crazy-paving surrounding the mass, which is perihilar. <br />61<br /> http://radiographics.rsna.org/content/23/6/1509/F24.expansion.html<br />
  64. 64. Case 11 / What diagnosis that do you expect?<br />Adenocarcinoma<br />BOOP.<br />Lipoidpneumonia<br />Diffuse pulmonary hemorrhage<br />P carinii pneumonia<br />62<br /> http://radiographics.rsna.org/content/23/6/1509/F24.expansion.html<br />
  65. 65. Case 11 / What diagnosis that do you expect?<br />Diffuse pulmonary hemorrhage<br />BOOP.<br />Lipoidpneumonia<br />Adenocarcinoma<br />P carinii pneumonia<br />63<br /> http://radiographics.rsna.org/content/23/6/1509/F24.expansion.html<br />
  66. 66. Case 11 / How do you explain the ground glass?<br />Lymphangitic carcinomatosis surrounding the central mass<br />Adenocarcinoma with surrounding pulmonary hemorrhage<br />64<br /> http://radiographics.rsna.org/content/23/6/1509/F24.expansion.html<br />
  67. 67. Case 11 / How do you explain the ground glass?<br />Lymphangitic carcinomatosis surrounding the central mass<br />Adenocarcinoma with surrounding pulmonary hemorrhage<br />65<br /> http://radiographics.rsna.org/content/23/6/1509/F24.expansion.html<br />

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