Crazy paving

Changed by Calum Worsley, 23 Sep 2022

Disclosures - updated 12 Apr 2022: Nothing to disclose

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Crazy paving refers to the appearance of ground-glass opacities with superimposed interlobular septal thickening and intralobular septal thickening, seen on chest HRCT or standard CT chest. It is a non-specific finding that can be seen in a number of conditions.

Pathology

Aetiology

Common causes:

acute respiratory distress syndrome (ARDS)
bacterial pneumonia
acute interstitial pneumonia: ARDS of unknown aetiology
pulmonary alveolar proteinosis (PAP): the great majority of patients with PAP demonstrate crazy paving

Less common causes:

drug-induced pneumonitis
radiation pneumonitis
pulmonary haemorrhage / diffuse pulmonary haemorrhage
- Goodpasture syndrome
chronic eosinophilic pneumonia
usual interstitial pneumonia (UIP) with superimposed diffuse alveolar damage
pulmonary oedema
pulmonary infections
cryptogenic organising pneumonia (COP, formerly BOOP)
invasive mucinous adenocarcinoma of the lung (formerly mucinous bronchoalveolar carcinoma)
sarcoidosis, especially alveolar sarcoidosis
lipoid pneumonia
pulmonary veno-occlusive disease

-<a href="/articles/invasive-mucinous-adenocarcinoma-of-the-lung-1">invasive mucinous adenocarcinoma of the lung</a> (formerly <a href="/articles/mucinous-bronchioloalveolar-carcinoma">mucinous bronchoalveolar carcinoma</a>
~~-</li>~~
+<a href="/articles/invasive-mucinous-adenocarcinoma-of-the-lung-1">invasive mucinous adenocarcinoma of the lung</a> (formerly <a href="/articles/mucinous-bronchioloalveolar-carcinoma">mucinous bronchoalveolar carcinoma</a>)</li>

References changed:

1. Johkoh T, Itoh H, Müller N et al. Crazy-Paving Appearance at Thin-Section CT: Spectrum of Disease and Pathologic Findings. Radiology. 1999;211(1):155-60. <a href="https://doi.org/10.1148/radiology.211.1.r99ap10155">doi:10.1148/radiology.211.1.r99ap10155</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10189465">Pubmed</a>
2. Lee C. The Crazy-Paving Sign. Radiology. 2007;243(3):905-6. <a href="https://doi.org/10.1148/radiol.2433041835">doi:10.1148/radiol.2433041835</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/17517945">Pubmed</a>
3. Frazier A, Franks T, Cooke E, Mohammed T, Pugatch R, Galvin J. From the Archives of the AFIP: Pulmonary Alveolar Proteinosis. Radiographics. 2008;28(3):883-99; quiz 915. <a href="https://doi.org/10.1148/rg.283075219">doi:10.1148/rg.283075219</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/18480490">Pubmed</a>
4. Rossi S, Erasmus J, Volpacchio M, Franquet T, Castiglioni T, McAdams H. "Crazy-Paving" Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview. Radiographics. 2003;23(6):1509-19. <a href="https://doi.org/10.1148/rg.236035101">doi:10.1148/rg.236035101</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/14615561">Pubmed</a>
5. Maimon N & Heimer D. The Crazy-Paving Pattern on Computed Tomography. CMAJ. 2010;182(14):1545. <a href="https://doi.org/10.1503/cmaj.091422">doi:10.1503/cmaj.091422</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/20547710">Pubmed</a>
1. Johkoh T, Itoh H, Müller NL et-al. Crazy-paving appearance at thin-section CT: spectrum of disease and pathologic findings. Radiology. 1999;211 (1): 155-60. <a href="http://radiology.rsna.org/content/211/1/155.full">Radiology (full text)</a> [<a href="http://www.ncbi.nlm.nih.gov/pubmed/10189465">pubmed citation</a>]
2. Lee CH. The crazy-paving sign. Radiology. 2007;243 (3): 905-6. <a href="http://dx.doi.org/10.1148/radiol.2433041835">doi:10.1148/radiol.2433041835</a> [<a href="http://www.ncbi.nlm.nih.gov/pubmed/17517945">pubmed citation</a>]
3. Frazier AA, Franks TJ, Cooke EO et-al. From the archives of the AFIP: pulmonary alveolar proteinosis. Radiographics. 2008;28 (3): 883-99. <a href="http://dx.doi.org/10.1148/rg.283075219">doi:10.1148/rg.283075219</a> [<a href="http://www.ncbi.nlm.nih.gov/pubmed/18480490">pubmed citation</a>]
4. Rossi SE, Erasmus JJ, Volpacchio M et-al. "Crazy-paving" pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics. 2003;23 (6): 1509-19. <a href="http://radiographics.rsna.org/content/23/6/1509.full">Radiographics (full text)</a> - <a href="http://dx.doi.org/10.1148/rg.236035101">doi:10.1148/rg.236035101</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/14615561">Pubmed citation</a><span class="ref_v3"></span>
5. Maimon N, Heimer D. The crazy-paving pattern on computed tomography. CMAJ. 2010;182 (14): 1545. <a href="http://www.cmaj.ca/content/182/14/1545.full">CMAJ (full text)</a> - <a href="http://dx.doi.org/10.1503/cmaj.091422">doi:10.1503/cmaj.091422</a> - <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950188">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/20547710">Pubmed citation</a><span class="auto"></span>

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Crazy paving

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