Crazy-paving sign in high-resolution computed tomography in parainfluenza virus pneumonia

Abstract

The crazy-paving sign is the appearance of a smooth linear pattern superimposed on an area of ground-glass opacity on thin-section computed tomography (CT). A 69-year-old woman was admitted to our hospital for treatment of pneumonia. Thoracic CT showed a crazy-paving sign in the right lung field on admission. She received ceftriaxone and clarithromycin, and the symptoms and infiltration shadow promptly disappeared. Serologic testing revealed a greater than 4-fold increase in the IgG titer for parainfluenza virus I. To our knowledge, there is no previous report of the crazy-paving sign in associated with viral pneumonia in a non-immunocompromised host or with parainfluenza pneumonia. a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / r a d i Radiography (2010) 16, 160e162

Pulmonary Alveolar Proteinosis

“…103,104 The crazy-paving pattern is not pathognomonic of pulmonary alveolar proteinosis, and occurs in other infectious or non-infectious conditions. [104][105][106][107][108][109][110][111][112][113][114] The subacute or chronic clinical course, absence of architectural distortion, smooth 78 Cryptococcus neoformans 79,80 Mycobacterium tuberculosis [81][82][83][84] Mycobacterium avium-intracellulare 85,86 inter-lobular septal thickening, geographical distribution, and discordance between the clinical and radiological features help differentiate pulmonary alveolar proteinosis from other causes of crazy paving. In a study of 42 patients, Ishii et al 115 reported differences in the pattern and distribution of ground-glass opacity on high-resolution CT, which help to differentiate secondary from autoimmune pulmonary alveolar proteinosis.…”

Sudden death in a man with pulmonary alveolar proteinosis: Postmortem radiology and autopsy findings

“…The classical pattern described is that of 'ground glass opacity' with thickening of intralobular and interlobular septa giving a 'crazy paving' pattern [10,11]. This is not pathognomic of PAP and can be observed in other conditions such as sarcoidosis, lipid pneumonia, PCP pneumonia, cryptogenic organizing pneumonia (COP) and mucinous bronchoalveolar carcinoma [12][13][14]. It should be noted that a major cofounder in any observation of postmortem imaging of the lungs is lividity.…”