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Thoracic Imaging |
1 From the Dept of Radiology, Osaka University Medical School, Japan (T.J., H.N.); Dept of Radiology, Vancouver Hospital and Health Sciences Centre and University of British Columbia, 855 W 12th Ave, Vancouver V5Z 1M9, Canada (T.J., N.L.M.); Dept of Radiology, Kyoto University Medical School, Japan (H.I.); First Dept of Internal Medicine, Kumamoto University School of Medicine, Japan (K.I.); Dept of Radiology, Ehime University Medical School, Japan (J.I.); Dept of Radiology, National Kinki Chuo Hospital for Chest Diseases, Osaka, Japan (M.A.); and Dept of Pathology, Izumisano Municipal Hospital, Osaka (T.N.). From the 1996 RSNA scientific assembly. Received Apr 2, 1998; revision requested Jun 29; final revision received Sep 8; accepted Oct 26. Address reprint requests to N.L.M.
PURPOSE: To determine the spectrum of diseases associated with a fine reticular pattern superimposed on areas of ground-glass opacity (ie, "crazy-paving" appearance) at thin-section computed tomography (CT) and to determine the underlying pathologic features.
MATERIALS AND METHODS: In the in vivo study, the cases of 46 patients (21 male, 25 female; age range, 13–82 years) were retrospectively reviewed, with special attention paid to the size and extent of the reticular network. In the in vitro study, the thin-section CT findings in 20 inflated and fixed lungs were precisely correlated with the gross appearance, contact radiograph findings, stereomicroscopic views, and histologic findings.
RESULTS: In the in vivo study, 15 different diseases were identified, including alveolar proteinosis, adult respiratory distress syndrome, acute interstitial pneumonia, diffuse alveolar damage superimposed on usual interstitial pneumonia, and drug-induced pneumonitis. In the in vitro study, the fine networks at pathologic analysis were due to an alveolar filling process (n = 10), an interstitial fibrotic process (n = 7), or a combination of interstitial and intraalveolar processes (n = 3). Twelve (60%) cases did not have thickening of the interlobular septa within the areas of the crazy-paving appearance.
CONCLUSION: The crazy-paving appearance is a nonspecific finding seen in a variety of interstitial and airspace lung diseases.
Index terms: Computed tomography (CT), comparative studies, 60.126, 60.1292, 68.11, 68.12118 • Computed tomography (CT), thin-section, 68.12118 • Lung, CT, 60.12118 • Lung, diseases, 60.2061, 60.2075, 60.213, 60.2173, 60.23, 60.4123, 60.413, 60.47, 60.632, 60.71 • Lung, infection, 60.20 • Pneumonia, acute interstitial, 60.213 • Proteinosis, pulmonary alveolar, 60.791 • Respiratory distress syndrome, adult, 60.413
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