Korean J Radiol.  2009 Feb;10(1):21-24. 10.3348/kjr.2009.10.1.21.

"Crazy-Paving" Patterns on High-Resolution CT Scans in Patients with Pulmonary Complications after Hematopoietic Stem Cell Transplantation

• Marchiori
• Escuissato DL
• Gasparetto TD
• Considera
• Franquet T

• KMID: 1088674
• DOI: http://doi.org/10.3348/kjr.2009.10.1.21

Abstract

OBJECTIVE
To describe the pulmonary complications following hematopoietic stem cell transplantation (HSCT) that can present with a "crazy-paving" pattern in high-resolution CT scans. MATERIALS AND METHODS: Retrospective review of medical records from 2,537 patients who underwent HSCT. The "crazy-paving" pattern consists of interlobular and intralobular septal thickening superimposed on an area of ground-glass attenuation on high-resolution CT scans. The CT scans were retrospectively reviewed by two radiologists, who reached final decisions by consensus. RESULTS: We identified 10 cases (2.02%), seven male and three female, with pulmonary complications following HSCT that presented with the "crazy-paving" pattern. Seven (70%) patients had infectious pneumonia (adenovirus, herpes simplex, influenza virus, cytomegalovirus, respiratory syncytial virus, and toxoplasmosis), and three patients presented with non-infectious complications (idiopathic pneumonia syndrome and acute pulmonary edema). The "crazy-paving" pattern was bilateral in all cases, with diffuse distribution in nine patients (90%), predominantly in the middle and inferior lung regions in seven patients (70%), and involving the anterior and posterior regions of the lungs in nine patients (90%). CONCLUSION: The "crazy-paving" pattern is rare in HSCT recipients with pulmonary complications and is associated with infectious complications more commonly than non-infectious conditions.

Keyword

Hematopoietic stem cell transplantation; High-resolution computed tomography; Crazy-paving pattern; Lung, infection

MeSH Terms

Adolescent
Adult
Female
Hematopoietic Stem Cell Transplantation/*adverse effects
Humans
Lung/*radiography
Lung Diseases/etiology/*radiography
Male
Middle Aged
Pneumonia/etiology/radiography
Pulmonary Edema/etiology/radiography
Respiratory Tract Infections/etiology/radiography
*Tomography, X-Ray Computed
Young Adult

Figure

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  Fig. 1 38-year-old man with adenovirus pneumonia high-resolution CT scan at level of upper lobes shows bilateral areas of ground-glass attenuation with superimposed interlobular septal thickening ("crazy-paving" pattern).

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  Fig. 2 16-year-old woman with toxoplasmosis. High-resolution CT scan at level of lower lung zones demonstrates bilateral ground-glass opacities with interlobular septal and intralobular interstitial thickening, "crazy-paving" pattern, associated with air-space consolidation areas.

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  Fig. 3 56-year-old man with idiopathic pneumonia syndrome. High-resolution CT scan at level of lower lung zones shows extensive "crazy-paving" pattern involving both lower lobes, lingula and middle lobe, in association with areas of air-space consolidation.

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  Fig. 4 28-year-old man with acute pulmonary edema. High-resolution CT scan at level of main bronchi demonstrates areas of consolidation and ground-glass attenuation with superimposed interlobular septal thickening defining "crazy-paving" pattern. Lesions predominated on left upper lobe. Bilateral pleural effusion is also observed.

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