crazy paving pattern

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  • crazy paving pattern

    1. 1. “Crazy-Paving” Pattern at Thin- Section CT of the Lungs: RadioGraphics 2003; 23:1509-1519
    2. 2. IntroductionReported in infectious, neoplastic, idiopathic, inhalational,and sanguineous disorder of the lungsCharacterized by scattered or diffuse ground-glassattenuation with superimposed interlobular septalthickening and intralobular lines
    3. 3. Infection• Pneumocystis carinii pneumonia (PCP)Neoplasm• Mucinous Bronchioalveolar Carcinoma (BAC)Idiopathic Disorders• Pulmonary Alveolar Proteinosis (PAP)• SarcoidosisInhalation Disorders• Lipoid PneumoniaSanguineous Disorders• Adult Respiratory Distress Syndrome (ARDS)• Pulmonary Hemorrhage Syndromes
    4. 4. eoplasmMucinous Bronchioalveolar Carcinoma (BAC) iopathic Disorders ulmonary Alveolar Proteinosis (PAP) arcoidosis halation Disorders ipoid Pneumonia
    5. 5. Pneumocystis Carinii• Symptoms: cough, dyspnea, low-grade fever• Chest Radiograph: – Bilateral, perihilar reticular and poorly defined ground-glass opacities  alveolar consolidation – Scattered ground-glass attenuation (interlobular septal thickening)• Histology: foamy nature of the alveolar exudates and thickening of the alveolar wa&s by edema and ce&ular infiltrates
    6. 6. Mucinous Bronchioalveolar Carcinoma (BAC) Mucinous  mucin-producing columnar ce&s with moderate nuclear atypia Lepidic growth pattern through the airways and air spaces with preservation of the lung architecture. Symptoms: Bronchorrhea
    7. 7. Mucinous Bronchioalveolar Carcinoma (BAC) Chest Radiography: i&-defined consolidation or ground-glass opacities occur in a focal or multilobar distribution Lymphadenopathy Pleural effusion Chest HRCT: Numerous and alveolar consolidation and ground-glass attenuation  crazy-paving pattern
    8. 8. Pulmonary AlveolarFi&ing of the alveoli by a proteinaceous materialAssociated with an inflammatory response in the adjacentinterstitiumMost common in adults, 20-50 years oldDyspnea and nonproductive coughLess common: Pleuritic chest pain, malaise, low-grade fever
    9. 9. Pulmonary AlveolarRadiography : bilateral, symmetric alveolar consolidation orground-glass opacity, particularly in perihilar or hilardistribution ~ pulmonary edemaHRCT : diffuse ground-glass attenuation with superimposedintra- and interlobular septal thickeningDiagnosis with bronchoalveolar lavage
    10. 10. SarcoidosisDevelopment of noncaseating granulomatous inflammationParenchymal findings: irregular thickening of thebronchovascular bundles and sma& nodules along vessels
    11. 11. Nonspecific InterstitialInterstitial inflammation and fibrosis with temporal andspatial uniformityDoes not fulfi& clinicopathologic criteria for usualinterstitial pneumonia, desquamative interstitialpneumonia, or acute interstitial pneumoniaChest Radiography: bilateral pulmonary opacities, mainlylocalized in the middle and lower zones
    12. 12. Nonspecific InterstitialChest CT findings: ground-glass attenuation, bilateral andsymmetric with a tendency to subpleural and basalpredominanceOther findings: Consolidation and irregular reticular linessuperimposed on a background of ground-glass attenuationHoneycombing is typica&y absent
    13. 13. Organizing PneumoniaPast: bronchiolitis obliterans organizing pneumoniaChronic inflammatory process characterized by focal plugs ofgranulation tissue (Masson bodies) in the lumina of distal sma&airwaysAssociated with intraalveolar foamy macrophages and interstitialce&ular responseMost cases are idiopathic (cyrptogenic organizing pneumonia)
    14. 14. Organizing PneumoniaAssociated with co&agen-vascular diseases, infection, andtoxic effect drugs (bleomycin, methotrexate,cyclophosphamide, gold salts, topotecan, amiodarone)Symptoms: cough, dyspnea, fever of several weeks, andleukocytosisResponse to steroid therapy
    15. 15. Organizing PneumoniaRadiography and CT: scattered and asymmetricconsolidation bilatera&y, and peripheral (> 50%)
    16. 16. Organizing PneumoniaHRCT: subpleural and peribronchovascular consolidation,crazy-paving pattern is uncommon
    17. 17. Exogenous LipoidPulmonary disorder resulting ,om chronic aspiration orinhalation of animal, vegetable, or petroleum-based oils orfatsPredisposing factors: structural abnormalities, neurologicdefects, and chronic i&nessHistopathologic: intraalveolar macrophages containingabundant cytoplasmic lipoproteinaceous material within‘normal’ alveoli
    18. 18. Exogenous LipoidSubacute manifestations: larger vacuoles within alveoli,surrounded by macrophages, inflammatory infiltrates ofalveolar wa&s and interlobular septaRisk factors: repeated episodes of aspirationSymptoms: mild ever, shortness of breath, and chestdiscomfort
    19. 19. Exogenous LipoidChest radiograph: nonspecific, bilateral lower-lobe airspaceopacities, mixed alveolar and interstitial opacities, andpoorly marginated focal mass-like lesions mimic pulmonaryneoplasm
    20. 20. Exogenous Lipoid Pneumonia Lipoid PneumoniaHRCT: consolidation characterized by low attenuation (-35 to -75 HU) lipid deposition Geographic ground-glass attenuation associated with interlobular septal thickening within areas of ground- glass attenuationIntraalveolar and interstitial accumulation of lipid-ladenmacrophages and hyperplasia of tyoe II pneumatocytes in
    21. 21. Exogenous LipoidDiagnosis: Bronchoalveolar lavage, transbronchial biopsy,or open lung biopsy combined with history of ingestion andradiographic studies.
    22. 22. Adult Respiratory Distress Syndrome (ARDS) Pulmonary edema characterized by re,actory hypoxemia and respiratory distress Risk Factors: Shock, contusion, infection, sepsis, aspiration, drug abuse, and inhalation of noxious substances Diagnosis: impaired diffusion capacity (DLCO), reduced compliance of the lung, and typical radiologic findings
    23. 23. Adult Respiratory Distress Syndrome (ARDS) Chest Radiography: Bilateral homogenous pulmonary opacities Cardiomegaly and upper-lobe diversion are usua&y absent Chest HRCT: Bilateral consolidation and ground-glass attenuation Reticular and linear attenuation
    24. 24. Adult Respiratory Distress Syndrome (ARDS) May progress to architectural distortion, consolidation with bronchiectasis, and honeycombing Histologic: Edema of the alveoli and perivascular spaces with fi&ing of the alveoli by a protein rich fluid
    25. 25. Pulmonary Hemorrhage Syndromes Wide spectrum of diseases: Idiopathic pulmonary hemosiderosis Wegener granulomatosis Churg-Strauss syndrome Goodpasture syndrome Co&agen-vascular disease (SLE) Drug-induced coagulopathy Hemorrhage associated with malignancy
    26. 26. Pulmonary Hemorrhage SyndromesDiffuse parenchymal bleeding: Hemodynamic modification of capi&ary pulmonary blood flow Pathologic changes in the alveolar wa&Symptoms: hemoptysis, dyspnea, and anemiaDiagnosis: Bronchoalveolar lavage or Fe content of alveolarmacrophages
    27. 27. Pulmonary Hemorrhage SyndromesOccurs up to 2% patients with SLE, associated withextrapulmonary manifestations like glomerulonephritis42 to 66 % patients do not have hemoptysisChest Radiograph and HRCT: asymmetric acinar and ground-glassopacities or attenuation and crazy-paving pattern
    28. 28. ConclusionsCrazy-paving pattern: scattered or diffuse ground-glassopacities or attenuation with superimposedinterlobular septal thickening and intralobular linesLimited differential diagnosis  CT manifestationsof many diverse entitiesKnowledge of the etiology prevent diagnostic errorsLocation of characteristics, additional radiologicfindings, history and clinical presentation can o-en beuseful in su.esting the appropriate diagnosis

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