crazy paving pattern in pulmonary alveolar proteinosis

Johkoh T, et al. sign of alveolar proteinosis. The aforementioned HRCT findings constitute the crazy-paving pattern, which is characterized by diffuse ground-glass opacities in the lung parenchyma, together with interlobular and intralobular septal thickening. Consider pulmonary alveolar proteinosis in adolescents with “crazy paving” pattern on imaging. The differential diagnosis for the “crazy-paving sign” is actually quite large and goes well beyond Pulmonary Alveolar Proteinosis (PAP). REVIEW: PULMONARY ALVEOLAR PROTEINOSIS c EUROPEAN RESPIRATORY REVIEW VOLUME 20 NUMBER 120 99. alveolar accumulation. Conflict of Interest. Nowadays this pattern is a common finding on high-resolution CT imaging, and can be seen in a number of acute and chronic diseases. 18.1. Department of Respiratory Medicine; 3. Crazy paving pattern caused by pulmonary alveolar proteinosis: CT findings and the pathologic basis (English) LUO Jianguang, YANG Dongyi, ZHOU Shunke, XIAO Enhua, CHEN Ping, FAN Songqing, LIU Jun: 1. Although the majority of patients with PAP will have a CT consistent with the crazy paving pattern, this radiographic pattern is by no means specific to PAP. 5A, 5B). Although this pattern is suggestive of the diagnosis of pulmonary alveolar proteinosis, this pattern can be seen in several air-space and interstitial diseases . 200, P16-P17, 2019 24–26 It was first used to describe the pattern of pulmonary alveolar proteinosis, but can be seen in a variety of diseases. Crazy paving refers to a pattern seen on computed tomography of the chest, involving lobular septal thickening with variable alveolar filling. These findings are characteristic but not unique to PAP. A chest CT showed a crazy-paving pattern. Department of Radiology; 2. Idiopathic Disorders Pulmonary Alveolar Proteinosis The crazy-paving pattern is a linear pattern superimposed on a background of ground-glass opacity, resembling irregularly shaped paving stones. Imaging description The classic appearance of pulmonary alveolar proteinosis is symmetric, predominately perihilar, ground-glass opacity with intralobular linear opacities and interlobular septal thickening (“crazy-paving” pattern) [1–3] (Figures 19.1–19.4). Radiographics 2003;23:1509. The crazy-paving pattern found on computed tomography of the lungs is a nonspecific radiologic sign named after the appearance of paths made with pieces of stone or concrete. CONCLUSION: Crazy paving pattern caused by pulmonary alveolar proteinosis displayed clear edges, and smooth reticular opacities, most of which were due to hemangiectasis of interlobular, interacinar and interalveolar septa. Pulmonary, Alveolar Proteinosis. Background: Although pulmonary alveolar proteinosis (PAP) and exogenous lipoid pneumonia (ELP) require different treatment strategies, both manifest as a crazy-paving pattern on CT and often have similar clinical manifestations and radiologic features. invasions. 17. Finaly pathology demonstrated findings consistent with pulmonary alveolar proteinosis, a rarely observed lung pathology that causes ‘crazy paving’. The pattern is caused by thickening of interlobular septa superimposed on areas of ground glass opacification. Rossi SE, et al. Anti-granulocyte macrophage-colony stimulating factor (anti-GM-CSF) antibody concentrations, the gold standard for diagnosis of pulmonary alveolar proteinosis, is not available in South Africa. Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disease characterised by alveolar accumulation of surfactant. Correlations with reticulation are less unequivocal and could correspond to interstitial disease (lipoproteinaceous interstitial accumulation, inflammation or oedema) or lipoproteinaceous alveolar accumulation on the edges of the lobules [21]. Request PDF | Crazy Paving in Pulmonary Alveolar Proteinosis | A 34-year-old man presented with dyspnea and a nonproductive cough. - Our case is a patient with biopsy proven pulmonary alveolar proteinosis. Her chest computed tomography scan showed a bilateral crazy-paving pattern in both of her lungs. crazy paving pattern typical of pulmonary alveolar proteinosis (fi gure). Reticulations are superimposed on ground-glass opacities forming a “crazy paving” pattern with a geographic distribution: juxtaposition of healthy and sick zones . Pulmonary alveolar proteinosis (PAP) is a rare disease of abnormal surfactant production and accumulation. Authorship Abstract. This pattern is considered to be caused by pulmonary alveolar proteinosis, but its association with various diseases is unclear. Very rarely, it also displays a “crazy paving” pattern (also described as a “paving stone,” “flagstone,” or “slabstone” pattern), which is rarer still in discrete bilateral nodules. The purpose of this paper is to illustrate different diseases that cause this crazy-paving pattern and to correlate the radiological findings from computed tomography with the histopathological findings. Crazy-paving. PAP. It may result from mutations in surfactant proteins or granulocyte macrophage-colony stimulating factor (GM-CSF) receptor genes, it may be secondary to toxic inhalation or haematological disorders, or it may be auto-immune, with anti-GM-CSF antibodies blocking … images of the lung tissue and may reveal a “crazy paving” pattern. CASE PRESENTATION A 32-year-old Caucasian man without a significant medical history pre-sented with a two-month history of progressively worsening dyspnea on exertion. Saved by Nicole Miller. What is the crazy paving pattern? ground glass opacities superimposed on a reticular pattern as the so-called ‘crazy paving’ pattern. Both processes lead to the accumulation of surfactant-rich material within alveoli i.e. The pattern observed is highly suggestive of the disease, although not pathognomonic. Acta Radiol. These findings of CT are helpful for the specific diagnosis of pulmonary alveolar proteinosis. It was first described in the late 1980s in patients with pulmonary alveolar proteinosis, but has now been described in association with at least 15 pulmonary diseases. Pulmonary Alveolar Proteinosis (PAP) Am J Respir Crit Care Med Vol. Fig. 2. Pulmonary Alveolar Proteinosis. The finding is seen in pulmonary alveolar proteinosis, and other diseases. She was diagnosed with autoimmune pulmonary alveolar proteinosis based on bronchoalveolar lavage findings and the presence of serum anti-granulocyte macrophage colony-stimulating factor antibodies. "Crazy-Paving" Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview. A bronchoscopic alveolar lavage revealed alveolar proteinaceous material compatible with the diag-nosis pulmonary alveolar proteinosis (PAP). The ground-glass attenuation reflects the low-density intraalveolar material (glycoprotein), whereas the superimposed reticular attenuation is due to infil-tration of the interstitium by inflammatory or tu-mor cells (12,13). • Delayed diagnosis due to infectious mimickers is common in the young age group. Reference: 1. There is often geographic sparing of secondary lobules and periphery of the lung. Pulmonary alveolar proteinosis (PAP) is an example of these processes with its typical radiological findings including ground glass opacities, parenchymal consolidation, and reticuloseptal reticulations leading to a non‐specific but characteristic crazy paving pattern. Bronchoalveolar lavage was performed, and a diagnosis of pulmonary alveolar proteinosis was made. Pulmonary alveolar proteinosis versus exogenous lipoid pneumonia showing crazy-paving pattern: Comparison of their clinical features and high-resolution CT findings. Very rarely, it also displays a “crazy paving” pattern (also described as a “paving stone,”“flagstone,” or “slabstone” pattern), which is rarer still in discrete bilateral nodules. Chest CT scan of a patient with autoimmune PAP. However, this pattern has subsequently been reported in a variety of pulmonary diseases and is now considered to be nonspecific. 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