The Clinical Significance of a ‘Crazy-Paving’ Pattern on Chest Radiology

Abstract

A crazy-paving pattern is a non-specific radiological sign which is characterized by the presence of diffuse ground-glass attenuation associated with interlobular septal thickening and intralobular lines. It was initially described as a pathognomonic sign of pulmonary alveolar proteinosis. However, it can be also found in many other diffuse acute and chronic lung diseases including diffuse alveolar haemorrhage (DAH), a rare and life-threatening clinical syndrome which can be caused by many conditions, the most frequent of these being capillaritis associated with systemic autoimmune diseases.In this case report, we describe an 82-year-old female patient with acute respiratory failure and bilateral pulmonary infiltrates with the characteristic crazy-paving pattern. The final diagnosis was isolated DAH induced by microscopic polyangiitis. The patient was treated with IV high dose prednisolone and cyclophosphamide and was mechanically ventilated. Nevertheless, her clinical status progressively deteriorated and she died after 3 days from acute respiratory distress syndrome.LEARNING POINTSA crazy-paving pattern is a non-specific radiological sign which is characterized by the presence of diffuse ground-glass attenuation associated with interlobular septal thickening.The presence of a crazy-paving pattern together with a progressive fall in haemoglobin levels suggests diffuse alveolar haemorrhage (DAH).A panel for collagen vascular diseases and vasculitis should be immediately performed in patients suspected of having DAH.

The Crazy-paving Pattern in Chest CT of Coronavirus Disease 2019 Patients; an Alarming Sign for Hospitalization 

“…The linear pattern is associated with interlobular septal thickening and intralobular lines and can also be caused by the presence of intralobular brosis, or a linear deposition of material within the airspaces (14). Although the crazypaving pattern was initially described as a pathognomonic sign of alveolar proteinosis, nowadays it counts as a non-speci c pattern that reported later in a variety of diffuse acute and chronic lung diseases including bacterial or viral pulmonary infection and adult (acute) respiratory distress syndrome (ARDS) (14,15). The overall distribution of COVID-19 patients with the crazy-paving pattern in different studies is around 5-36% (12).…”

Correlation Study of Chest CT Features of Severe/Critical type COVID-19 with Early Renal Damage and Clinical Prognosis

“…The crazy-paving pattern can be de ned as diffuse or scattered ground-glass attenuation superimposed on a network of interlobular septal thickeding and intralobular lines [18]. In 1958, Rosen SH et al rst described crazy-paving appearance and proved that it can appear in pulmonary alveolar proteinosis (PAP) [19].…”

A compact CNN model for automated detection of COVID-19 using thorax x-ray images

“…However, radiographical imaging like Chest Computed Tomography (CT) Scan and Chest x-ray are essential in early diagnosis and management of treatment. This is a well-explored field of research [13][14][15][16]. Some advantages of using xrays are triaging, accessibility, potable equipment and, most importantly, cost efficiency compared to CT scans and RT-PCR.…”

“…It affects the lower lobes of both lungs, particularly the posterior segments, with a mainly peripheral and subpleural distribution. The X-ray can identify the infection if it shows a progression of lesions, septal thickening, or a Crazy Paving Pattern of opacities [15]. The performance was compared with other illustrious techniques like VGG16 and VGG19.…”