Crazy Paving

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August 22, 2011 by dailybolusoflr

Crazy Paving

“Crazy Paving” is a radiographic finding on thin-slice CT. It gets its name from the pattern of pavement called “crazy paving” seen here.

The patient in this case presented with SOB, pleuritic chest pain and non-massive hemoptysis.

·It is a linked linear pattern which is superimposed on a ground glass opacity.

·The linear pattern results from thickening of the inter-lobular septa and the ground glass opacities result from partial filling of the airspaces.

·It was initially described in Pulmonary Alveolar Proteinosis (super rare disorder with alveolar filling of phosholipid and protein compounds)

·Now realized to be a more non-specific finding that is seen in both acute and chronic disorders

·Acute: ARDS, multiple forms of pneumonia (interstitial, bacterial, mycoplasma, eosinophilic, PCP) pulmonary edema, pulmonary hemorrhage, drug induced pneumonitis

·Chronic: Radiation pneumonitis, alveolar proteinosis, bronchioalveolar cell carcinoma

Closer history revealed that this patient had developed symptoms while smoking marijuana. His presumptive diagnosis was drug induced pneumonitis.

April 1999 Radiology, 211, 155-160.

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