"Crazy-paving" pattern: A characteristic presentation of pulmonary alveolar proteinosis and a review of the literature from India

Kunal, Shekhar; Gera, Kamal; Pilaniya, Vikas; Jain, Sudhir; Gothi, Rajesh; Shah, Ashok

doi:10.4103/0970-2113.180936

Cited by 5 publications

(6 citation statements)

References 27 publications

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“…The most common CT findings seen in these patients were isolated GGO, GGO with reticular or interlobular septal thickening, and GGO in combination with consolidative opacities [15]. Air bronchograms were reported in 80% of these patients [16]. In this retrospective case series, we noted each had abnormalities present in their CT scans with the goal of familiarizing radiologists and clinical teams with identifying the radiological features of infected with the COVID-19 of this new outbreak.…”

Section: Discussionmentioning

confidence: 88%

“…Some patients were characteristically described as crazy-paving pattern, of which the reticular network in it is thought to represent the thickened interlobular septa while the GGO reflect the alveolar filling with periodic acid-Schiff-positive material. The mechanisms thought to be responsible for this pattern include interstitial fibrotic processes, alveolar filling processes, or a combination of both [16]. We also noted the number of lobes of the lungs that were affected with ground glass opacities and consolidation.…”

Section: Discussionmentioning

confidence: 93%

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CT imaging features of 34 patients infected with COVID-19

Zhang

Kong

et al. 2020

Clinical Imaging

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To retrospectively analyze the CT findings in patients infected with Coronavirus disease 2019 . Materials and methods: The thirty-four cases, 15 females and 19 males, with an age ranging from 7 to 88 years old, confirmed by real-time reverse-transcriptase-polymerase chain reaction (RT-PCR), were used for our study. All thin-section CT scans of the lungs were performed in all of patients. The clinical, laboratory and CT imaging were available to evaluate in all patients. Results: The patients present with fever (85.29%, n = 29), cough (67.65%, n = 23), fatigue or myalgia (26.47%, n = 9), and pharyngalgia (8.82%, n = 3). The 4 patients (11.76%) with no symptoms were identified during screening for close contacts, who had typical CT findings. On initial CT scans, the bilateral lung involved was shown in 24 cases (70.59%), while 29 (82.35%) cases were distributed in peripheral. The pure ground glass opacity (GGO) was shown in 18 cases (52.94%), the GGO with consolidation was in 12 cases (35.29%), and full consolidation only in 3 cases. The lesion with air bronchogram was seen in 14 (41.18%) cases, with enlarged blood vessel in 17 (50.00%) cases, with crazy-paving pattern in 8 (23.53%) cases, with fine reticular pattern in 4 (11.77%) cases, and with intralesional vacuole sign in 6 (17.65%) cases. The pleural effusion was seen in one patient. Follow-up imaging in 19 patients during the study time window demonstrated mild, moderate or severe progression of disease, as manifested by increasing extent and density of lung opacities. Conclusions: The bilateral GGO with air bronchogram, enlarged blood vessel, fine reticular pattern, and peripheral distribution are the early CT findings of COVID-19. The crazy-paving pattern and intralesional vacuole sign are the features of progressive stage.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 93%

CT imaging features of 34 patients infected with COVID-19

Zhang

Kong

et al. 2020

Clinical Imaging

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“…Other series also reported that residual gas exchange abnormalities and exercise intolerance were common, even in the absence of recurrent PAP. [ 15 ] A review of Indian literature has shown that WLL as a therapeutic modality was used in 60% (18/30), and all of those showed satisfactory response,[ 16 ] but long-term follow-up data on effects of WLL in these patients are not available. We have previously reported good response to bilateral WLL in two patients.…”

Section: Discussionmentioning

confidence: 99%

“…Although PAP is a rare condition, physicians treating such patients should not make the diagnosis of tuberculosis on radiologic basis alone as it is inappropriate to treat these patients with ATT in the absence of microbiological confirmation. [ 20 ] Progressive dyspnea, worsening oxygenation, high serum LDH, and typical “crazy-paving” pattern on radiology[ 16 ] may be a helpful clue.…”

Section: Discussionmentioning

confidence: 99%

Management of primary pulmonary alveolar proteinosis: A multicentric experience

Marwah¹,

Katoch²,

Singh

et al. 2020

Lung India

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“…The ‘crazy-paving’ pattern, on high-resolution computed tomography (HRCT) of the chest, is a specific radiological appearance that was first described in patients with pulmonary alveolar proteinosis (PAP). [ 1 ] Although this distinctive pattern is still considered to be the imaging hallmark of PAP, it has now emerged that this characteristic radiological manifestation is rather non-specific and has since been described in several clinical entities. [ 2 - 4 ] The ‘crazy-paving’ pattern has also been reported in a few patients with malignancies of the lung.…”

Section: Introductionmentioning

confidence: 99%

Unilateral ‘Crazy-Paving’ pattern: An exceptional presentation of squamous cell carcinoma of the lung

Shah

Banday

Khan

et al. 2022

Journal of Family Medicine and Primary Care

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A BSTRACT The ‘crazy-paving’ pattern on high resolution computed tomography (HRCT) is a distinct imaging appearance that is still considered to be a radiological hallmark of pulmonary alveolar proteinosis. However, since its first description about three decades ago, more than 40 different clinical entities presenting as ‘crazy-paving’ patterns have been documented. This rather remarkable but uncommon imaging appearance is now considered to be a non-specific manifestation. A 62-year-old male referred for evaluation of productive cough, breathlessness and fever presented with ‘crazy-paving’ pattern on HRCT. Endobronchial biopsy done on presentation was consistent with the diagnosis of squamous cell carcinoma. This report highlights this atypical presentation of squamous cell carcinoma of the lung and adds to the increasing list of clinical entities presenting as a ‘crazy-paving’ pattern. To our knowledge, squamous cell carcinoma presenting as a ‘crazy-paving’ pattern on HRCT is yet to be documented.

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"Crazy-paving" pattern: A characteristic presentation of pulmonary alveolar proteinosis and a review of the literature from India

Cited by 5 publications

References 27 publications

CT imaging features of 34 patients infected with COVID-19

CT imaging features of 34 patients infected with COVID-19

Management of primary pulmonary alveolar proteinosis: A multicentric experience

Unilateral ‘Crazy-Paving’ pattern: An exceptional presentation of squamous cell carcinoma of the lung

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