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Crazy paving pattern

MedGen UID:
1376678
•Concept ID:
C4476749
•
Finding
Synonyms: Crazy paving appearance; Crazy paving sign; Crazy-paving pattern; GGO and reticulation; Ground glass opacity with reticulation
 
HPO: HP:0025391

Definition

The so-called crazy paving pattern appears as thickened interlobular septa and intralobular lines superimposed on a background of ground-glass opacity, resembling irregularly shaped paving stones. The crazy-paving pattern is often sharply demarcated from more normal lung and may have a geographic outline. It was originally reported in patients with alveolar proteinosis and is also encountered in other diffuse lung diseases that affect both the interstitial and airspace compartments, such as lipoid pneumonia. [from HPO]

Conditions with this feature

Interstitial lung disease due to ABCA3 deficiency
MedGen UID:
410074
•Concept ID:
C1970456
•
Disease or Syndrome
For a general phenotypic description and a discussion of genetic heterogeneity of pulmonary surfactant metabolism dysfunction, see SMDP1 (265120).
See: Condition Record
Interstitial lung disease due to ABCA3 deficiency

Professional guidelines

PubMed

RSNA-STR-ACR Consensus Statement for COVID-19 CT Patterns: Interreader Agreement in 240 Consecutive Patients and Association With RT-PCR Status.
Silva CF, Alegria J, Ramos C, Verdugo J, Diaz JC, Varela C, Barbe M
J Comput Assist Tomogr 2021 May-Jun 01;45(3):485-489. doi: 10.1097/RCT.0000000000001162. PMID: 33797444
CT differential diagnosis of COVID-19 and non-COVID-19 in symptomatic suspects: a practical scoring method.
Luo L, Luo Z, Jia Y, Zhou C, He J, Lyu J, Shen X
BMC Pulm Med 2020 May 7;20(1):129. doi: 10.1186/s12890-020-1170-6. PMID: 32381057Free PMC Article
Lipoid pneumonia in children following aspiration of mineral oil used in the treatment of constipation: high-resolution CT findings in 17 patients.
Zanetti G, Marchiori E, Gasparetto TD, Escuissato DL, Soares Souza A Jr
Pediatr Radiol 2007 Nov;37(11):1135-9. Epub 2007 Sep 18 doi: 10.1007/s00247-007-0603-1. PMID: 17876572

Recent clinical studies

Etiology

Pulmonary Manifestations of GATA2 Deficiency.
Marciano BE, Olivier KN, Folio LR, Zerbe CS, Hsu AP, Freeman AF, Filie AC, Spinner MA, Sanchez LA, Lovell JP, Parta M, Cuellar-Rodriguez JM, Hickstein DD, Holland SM
Chest 2021 Oct;160(4):1350-1359. Epub 2021 Jun 3 doi: 10.1016/j.chest.2021.05.046. PMID: 34089740Free PMC Article
Pulmonary alveolar proteinosis.
Bonella F, Campo I
Pneumologia 2014 Jul-Sep;63(3):144, 147-55. PMID: 25420289
Crazy paving pattern caused by pulmonary alveolar proteinosis: CT findings and the pathologic basis.
Luo J, Yang D, Zhou S, Xiao E, Chen P, Fan S, Liu J
Zhong Nan Da Xue Xue Bao Yi Xue Ban 2014 Sep;39(9):924-9. doi: 10.11817/j.issn.1672-7347.2014.09.010. PMID: 25269500
Pulmonary alveolar proteinosis.
Borie R, Danel C, Debray MP, Taille C, Dombret MC, Aubier M, Epaud R, Crestani B
Eur Respir Rev 2011 Jun;20(120):98-107. doi: 10.1183/09059180.00001311. PMID: 21632797Free PMC Article
Signs in chest imaging.
Algın O, Gökalp G, Topal U
Diagn Interv Radiol 2011 Mar;17(1):18-29. Epub 2010 Jul 28 doi: 10.4261/1305-3825.DIR.2901-09.1. PMID: 20669122

Diagnosis

Pulmonary Manifestations of GATA2 Deficiency.
Marciano BE, Olivier KN, Folio LR, Zerbe CS, Hsu AP, Freeman AF, Filie AC, Spinner MA, Sanchez LA, Lovell JP, Parta M, Cuellar-Rodriguez JM, Hickstein DD, Holland SM
Chest 2021 Oct;160(4):1350-1359. Epub 2021 Jun 3 doi: 10.1016/j.chest.2021.05.046. PMID: 34089740Free PMC Article
Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review.
Ye Z, Zhang Y, Wang Y, Huang Z, Song B
Eur Radiol 2020 Aug;30(8):4381-4389. Epub 2020 Mar 19 doi: 10.1007/s00330-020-06801-0. PMID: 32193638Free PMC Article
Pulmonary alveolar proteinosis.
Bonella F, Campo I
Pneumologia 2014 Jul-Sep;63(3):144, 147-55. PMID: 25420289
Signs in chest imaging.
Algın O, Gökalp G, Topal U
Diagn Interv Radiol 2011 Mar;17(1):18-29. Epub 2010 Jul 28 doi: 10.4261/1305-3825.DIR.2901-09.1. PMID: 20669122
"Crazy-paving" pattern at thin-section CT of the lungs: radiologic-pathologic overview.
Rossi SE, Erasmus JJ, Volpacchio M, Franquet T, Castiglioni T, McAdams HP
Radiographics 2003 Nov-Dec;23(6):1509-19. doi: 10.1148/rg.236035101. PMID: 14615561

Therapy

A "Crazy Paving" Pattern on CT Scan in a Patient Treated with Pembrolizumab.
Marvisi M, Ramponi S, Balzarini L, Mancini C
Curr Drug Saf 2019;14(3):242-245. doi: 10.2174/1574886314666190312115648. PMID: 30864509Free PMC Article
Crazy Paving Pattern.
Lussi C, Christ M, Flömer F
Dtsch Arztebl Int 2018 Oct 19;115(42):714. doi: 10.3238/arztebl.2018.0714b. PMID: 30479258Free PMC Article
'Crazy-paving' pattern: an exceptional presentation of cryptogenic organising pneumonia associated with chronic obstructive pulmonary disease.
Kunal S, Pilaniya V, Jain S, Shah A
BMJ Case Rep 2016 May 6;2016 doi: 10.1136/bcr-2016-215445. PMID: 27154992Free PMC Article
Pulmonary alveolar proteinosis.
Bonella F, Campo I
Pneumologia 2014 Jul-Sep;63(3):144, 147-55. PMID: 25420289
Pulmonary alveolar proteinosis.
Wang T, Lazar CA, Fishbein MC, Lynch JP 3rd
Semin Respir Crit Care Med 2012 Oct;33(5):498-508. Epub 2012 Sep 21 doi: 10.1055/s-0032-1325160. PMID: 23001804

Prognosis

Pulmonary alveolar proteinosis.
Jouneau S, Ménard C, Lederlin M
Respirology 2020 Aug;25(8):816-826. Epub 2020 May 3 doi: 10.1111/resp.13831. PMID: 32363736
Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review.
Ye Z, Zhang Y, Wang Y, Huang Z, Song B
Eur Radiol 2020 Aug;30(8):4381-4389. Epub 2020 Mar 19 doi: 10.1007/s00330-020-06801-0. PMID: 32193638Free PMC Article
Pulmonary alveolar proteinosis.
Wang T, Lazar CA, Fishbein MC, Lynch JP 3rd
Semin Respir Crit Care Med 2012 Oct;33(5):498-508. Epub 2012 Sep 21 doi: 10.1055/s-0032-1325160. PMID: 23001804
Pulmonary alveolar proteinosis.
Borie R, Danel C, Debray MP, Taille C, Dombret MC, Aubier M, Epaud R, Crestani B
Eur Respir Rev 2011 Jun;20(120):98-107. doi: 10.1183/09059180.00001311. PMID: 21632797Free PMC Article
Lipoid pneumonia: an overview.
Hadda V, Khilnani GC
Expert Rev Respir Med 2010 Dec;4(6):799-807. doi: 10.1586/ers.10.74. PMID: 21128754

Clinical prediction guides

Pulmonary Manifestations of GATA2 Deficiency.
Marciano BE, Olivier KN, Folio LR, Zerbe CS, Hsu AP, Freeman AF, Filie AC, Spinner MA, Sanchez LA, Lovell JP, Parta M, Cuellar-Rodriguez JM, Hickstein DD, Holland SM
Chest 2021 Oct;160(4):1350-1359. Epub 2021 Jun 3 doi: 10.1016/j.chest.2021.05.046. PMID: 34089740Free PMC Article
The Clinical and Chest CT Features Associated With Severe and Critical COVID-19 Pneumonia.
Li K, Wu J, Wu F, Guo D, Chen L, Fang Z, Li C
Invest Radiol 2020 Jun;55(6):327-331. doi: 10.1097/RLI.0000000000000672. PMID: 32118615Free PMC Article
Crazy paving pattern caused by pulmonary alveolar proteinosis: CT findings and the pathologic basis.
Luo J, Yang D, Zhou S, Xiao E, Chen P, Fan S, Liu J
Zhong Nan Da Xue Xue Bao Yi Xue Ban 2014 Sep;39(9):924-9. doi: 10.11817/j.issn.1672-7347.2014.09.010. PMID: 25269500
Pulmonary alveolar proteinosis.
Borie R, Danel C, Debray MP, Taille C, Dombret MC, Aubier M, Epaud R, Crestani B
Eur Respir Rev 2011 Jun;20(120):98-107. doi: 10.1183/09059180.00001311. PMID: 21632797Free PMC Article
Lipoid pneumonia: an overview.
Hadda V, Khilnani GC
Expert Rev Respir Med 2010 Dec;4(6):799-807. doi: 10.1586/ers.10.74. PMID: 21128754

Recent systematic reviews

Computed tomography features of COVID-19 in children: A systematic review and meta-analysis.
Wang JG, Mo YF, Su YH, Wang LC, Liu GB, Li M, Qin QQ
Medicine (Baltimore) 2021 Sep 24;100(38):e22571. doi: 10.1097/MD.0000000000022571. PMID: 34559092Free PMC Article
Temporal changes of haematological and radiological findings of the COVID-19 infection-a review of literature.
Lim AYH, Goh JL, Chua MCW, Heng BH, Abisheganaden JA, George PP
BMC Pulm Med 2021 Jan 22;21(1):37. doi: 10.1186/s12890-020-01389-z. PMID: 33482780Free PMC Article
CT Manifestations and Clinical Characteristics of 1115 Patients with Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-analysis.
Wan S, Li M, Ye Z, Yang C, Cai Q, Duan S, Song B
Acad Radiol 2020 Jul;27(7):910-921. Epub 2020 May 5 doi: 10.1016/j.acra.2020.04.033. PMID: 32505599Free PMC Article
Coronavirus Disease 2019 (COVID-19) CT Findings: A Systematic Review and Meta-analysis.
Bao C, Liu X, Zhang H, Li Y, Liu J
J Am Coll Radiol 2020 Jun;17(6):701-709. Epub 2020 Mar 25 doi: 10.1016/j.jacr.2020.03.006. PMID: 32283052Free PMC Article
Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients.
Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A
AJR Am J Roentgenol 2020 Jul;215(1):87-93. Epub 2020 Mar 14 doi: 10.2214/AJR.20.23034. PMID: 32174129

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