Crazy paving

Last revised by Tariq Walizai on 29 Dec 2024

Citation, DOI, disclosures and article data

Citation:

Amini B, Walizai T, Borderías L, et al. Crazy paving. Reference article, Radiopaedia.org (Accessed on 23 Mar 2025) https://doi.org/10.53347/rID-1180

DOI:

https://doi.org/10.53347/rID-1180

Permalink:

https://radiopaedia.org/articles/1180?embed_domain=fkgfeaby.ebecbve.dbzX50X8c3X8e

rID:

1180

Article created:

2 May 2008, Behrang Amini

Disclosures:

At the time the article was created Behrang Amini had no recorded disclosures.

View Behrang Amini's current disclosures

Last revised:

29 Dec 2024, Tariq Walizai

Disclosures:

At the time the article was last revised Tariq Walizai had no financial relationships to ineligible companies to disclose.

View Tariq Walizai's current disclosures

Revisions:

29 times, by 17 contributors - see full revision history and disclosures

Systems:

Chest

Sections:

Signs, Gamuts

Tags:

hrct

Synonyms:

Crazy paving pattern in lung
Crazy paving appearance
Crazy paving appearance in the lung
Crazy paving pattern

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:

pulmonary oedema (most common)
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 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

Quiz questions

References

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. doi:10.1148/radiology.211.1.r99ap10155 - Pubmed
2. Lee C. The Crazy-Paving Sign. Radiology. 2007;243(3):905-6. doi:10.1148/radiol.2433041835 - Pubmed
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. doi:10.1148/rg.283075219 - Pubmed
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. doi:10.1148/rg.236035101 - Pubmed
5. Maimon N & Heimer D. The Crazy-Paving Pattern on Computed Tomography. CMAJ. 2010;182(14):1545. doi:10.1503/cmaj.091422 - Pubmed
6. Yu H, Wang K, Huang D et al. Crazy‐paving Patterns as Rare Radiological Manifestations of Pulmonary Cryptococcosis: A Case Report. BMC Pulm Med. 2021;21(1):1-5. doi:10.1186/s12890-021-01450-5
7. De Wever W, Meersschaert J, Coolen J, Verbeken E, Verschakelen J. The Crazy-Paving Pattern: A Radiological-Pathological Correlation. Insights Imaging. 2011;2(2):117-32. doi:10.1007/s13244-010-0060-5 - Pubmed
8. Marchiori E, Escuissato D, Gasparetto T, Considera D, Franquet T. "Crazy-Paving" Patterns on High-Resolution CT Scans in Patients with Pulmonary Complications After Hematopoietic Stem Cell Transplantation. Korean J Radiol. 2009;10(1):21. doi:10.3348/kjr.2009.10.1.21 - Pubmed
9. Ehab A & Braga R. The Clinical Significance of a ‘Crazy-Paving’ Pattern on Chest Radiology. European Journal of Case Reports in Internal Medicine. 2018;5(12):1. doi:10.12890/2018_000978