The crazy-paving pattern in exogenous lipoid pneumonia: CT-pathologic correlation.

Franquet, Tomás; Giménez, A.; Bordés, R; Rodríguez-Arias, J.M.; Castellà, J

doi:10.2214/ajr.170.2.9456935

Cited by 99 publications

(62 citation statements)

References 8 publications

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“…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.…”

Section: High-resolution Computed Tomographymentioning

confidence: 99%

Pulmonary Alveolar Proteinosis

Khan

Agarwal

2011

Respir Care

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Section: High-resolution Computed Tomographymentioning

confidence: 99%

Pulmonary Alveolar Proteinosis

Khan

Agarwal

2011

Respir Care

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“…Mucinous bronchioloalveolar carcinoma is the only neoplastic disease reported with this pattern. Talcosis, asbestosis and exogenous lipoid pneumonia are inhalational insults that are associated with a crazy-paving appearance (3,6,7). In this regard, it is noteworthy that the patient described in the present report had a history of asbestos exposure with characteristic calcified pleural plaques.…”

Section: Case Presentationmentioning

confidence: 58%

“…The idiopathic group includes pulmonary alveolar proteinosis, sarcoidosis, nonspecific interstitial pneumonitis, usual interstitial pneumonitis, acute interstitial pneumonitis and cryptogenic organizing pneumonia (3,(6)(7)(8). Pulmonary hemorrhage syndromes and the acute respiratory distress syndrome have been associated with a crazy-paving pattern (3,9,10).…”

Section: Case Presentationmentioning

confidence: 99%

Progressive Dyspnea Associated with a Crazy‐Paving Appearance on a Chest Computed Tomography Scan

Maimon

Paul

Downey

2006

Canadian Respiratory Journal

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N Maimon, N Paul, GP Downey. Progressive dyspnea associated with a crazy-paving appearance on a chest computed tomography scan. Can Respir J 2006;13(5):269-271.A 'crazy-paving' appearance of the lungs on computed tomography scanning of the chest was first described nearly 20 years ago in patients with pulmonary alveolar proteinosis, and was thought to be characteristic of this condition. However, this pattern has subsequently been reported in a variety of pulmonary diseases and is now considered to be nonspecific. The present report describes a case of a 74-year-old man in whom congestive heart failure presented with a crazy-paving appearance of the lungs on a chest computed tomography scan. This uncommon association illustrates the importance of the correlation of clinical and radiographic information.Key Words: Computed tomography; Congestive heart failure; Crazy-paving appearance; Pulmonary alveolar proteinosis Dyspnée progressive associée à un aspect en verre dépoli à la scintigraphie thoracique Un aspect en verre dépoli à la scintigraphie pulmonaire a été décrit pour la première fois il y a près de 20 ans chez des patients qui souffraient de protéinose alvéolaire pulmonaire et on croyait qu'il était caractéristique de cette maladie. Or, ce motif a par la suite été signalé en lien avec diverses maladies pulmonaires et est désormais considéré non spécifique. Le présent rapport décrit le cas d'un homme de 74 ans atteint d'insuffisance cardiaque congestive chez qui on a noté à la scintigraphie pulmonaire un aspect en verre dépoli. Ce signe rare illustre l'importance d'établir une corrélation entre les renseignements cliniques et radiographiques.A 'crazy-paving' appearance of the lungs on a high-resolution computed tomography (CT) scan of the chest, defined as scattered or diffuse ground-glass attenuation superimposed on a network of interlobular septal thickening and intralobular lines, was first described in association with pulmonary alveolar proteinosis nearly 20 years ago (1,2). Initially, this radiographic pattern was thought to be specific for alveolar proteinosis, but has subsequently been reported in a variety of interstitial and airspace pulmonary disorders (3,4). In the present report, we describe a man who presented with progressive exertional dyspnea in association with a high-resolution chest CT scan that demonstrated a typical crazy-paving appearance. Subsequent investigations and his clinical course demonstrated the cause for the abnormal radiographic changes to be pulmonary edema secondary to congestive heart failure. The association of cardiogenic pulmonary edema, a common condition, with a crazy-paving appearance on a CT scan of the lungs has been reported previously in only three cases, but it is important for clinicians and radiologists to recognize. CASE PRESENTATIONA 74-year-old man presented with a nine-week history of progressive exertional dyspnea and fatigue during which time his exercise tolerance declined from almost unlimited to less than one flight of stairs. There was no history o...

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“…Although this finding is seen in a variety of interstitial and airspace lung diseases, associated with a compatible clinical history, it is suggestive of exogenous lipoid pneumonia [4]. On pathological examination, the ground-glass attenuation and thickened interlobular septa have been shown to represent numerous lipid-laden macrophages that fill and distend the alveolar walls and interstitium, where they may be associated with accumulation of lipid material, inflammatory cellular infiltration and a variable amount of fibrosis [5].…”

Section: Discussionmentioning

confidence: 99%

Lung infiltrate in a male with a bronchopleural fistula

Raynaud¹,

Crestani²,

Grossin³

et al. 2003

Eur Respir J

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A 49-yr-old male was admitted to the Pulmonology Unit of Bichat Hospital (Paris, France) in February 2001 due to minor haemoptysis. He had a history of right upper lobe tuberculosis in 1970, complicated with secondary aspergilloma in 1999 and treated with itraconazole between April and October 1999. In November 1999, he presented with right pleural empyema (local samples yielded Pseudomonas aeruginosa and Streptococcus sanguis) due to a bronchopleural fistula ( fig. 1a). Right open thoracostomy was performed in December 1999 and daily local care provided for 14 months until admission. On questioning, he denied experiencing fever, weight loss and shortness of breath.Physical examination results were normal. The pleural cavity was clean and sterile and the bronchopleural fistula still open. Laboratory results, including white blood cell count and erythrocyte sedimentation rate, were normal.The chest radiograph is shown in figure 1b.Computed tomography was also performed ( fig. 2). Fibreoptic bronchoscopy revealed post-tuberculous scarring in the right bronchial tree. Results of bacteriological and mycological studies were negative, as was the search for Mycobacterium tuberculosis.Bronchoalveolar lavage was performed in the left upper lobe. The resultant fluid was whitish and contained 200,000 cells?mL -1 : 71% macrophages, 21% lymphocytes, 8% neutrophils, and 1% eosinophils. Oil red O stain results are shown in figure 3.

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The crazy-paving pattern in exogenous lipoid pneumonia: CT-pathologic correlation.

Cited by 99 publications

References 8 publications

Pulmonary Alveolar Proteinosis

Pulmonary Alveolar Proteinosis

Progressive Dyspnea Associated with a Crazy‐Paving Appearance on a Chest Computed Tomography Scan

Lung infiltrate in a male with a bronchopleural fistula

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