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Secondary pulmonary lobule crazy paving sign
1. Dr MazenQusaibatyMD, DISHead Pulmonary and Internist Department Ibnalnafisse HospitalMinistry of Syrian healthEmail: Qusaibaty@gmail.com Secondary pulmonary lobule Crazy paving sign
21. Crazy paving sign Refers to the combination of ground glass attenuation superimposed on a network of interlobular septal thickening giving it an appearance of a surface paved with slabs of differing shapes 21
22. 22 Crazy paving sign Crazy Paving is a combination of ground glass opacity with superimposed net of septal thickening
33. Causes of the crazy-paving pattern 33 http://radiographics.rsna.org/content/23/6/1509/F2.expansion.html
34. Case 01 /Crazy Paving sign Thin-section CT scan of right upper lobe 34
35. Case 01 / Crazy Paving sign A fine reticular pattern superimposed on a background of ground-glass opacity—that is, the crazy-paving pattern. 35
36. Case 01 / Crazy Paving sign Fluid within the major fissure(arrowheads) 36
37. Case 01 / Crazy Paving sign A 32-year-old man with ARDS 37
38. Case 02 / Thin-section CT scan of right lower lobe The crazy-paving pattern is present in the right lower lobe, particularly in the region circumscribed by the arrowheads 38
39. Case 02 / Crazy Paving sign The minimum and maximum sizes of each frame of the network are 2 and 6 mm, respectively. 39
40. Case 02 / Crazy Paving sign A 65-year-old woman with chronic eosinophilic pneumonia 40
41. Case 03 / Thin-section CT scan of the left lower lobe Crazy-paving appearance, which is best seen in the region circumscribed by the arrows. 41
42. Case 03 / Postmortem findings in a 41-year-old woman Alveolar Hemorrhage 42
43. Case 04 / High-resolution CT scan Areas of ground-glass attenuation with intralobular lines 43 http://radiographics.rsna.org/content/23/6/1509/F3.expansion.html
44. P carinii pneumonia in a 32-year-old man with acquired immunodeficiency syndrome. 44 http://radiographics.rsna.org/content/23/6/1509/F3.expansion.html
45. Case 04 / Photomicrograph (original magnification, ×400; Grocott stain) of a specimen obtained with bronchoalveolar lavage shows alveolar exudates that contain cystic forms of P carinii (arrows) 45 http://radiographics.rsna.org/content/23/6/1509/F4.expansion.html
46. Case 05 / Diffuse mucinous bronchioloalveolar carcinoma in a 78-year-old man / High-resolution CT scan shows a bilateral crazy-paving pattern and centrilobular nodules. 46 http://radiographics.rsna.org/content/23/6/1509/F5.expansion.html
47. Case 06 / Sarcoidosis in a 25-year-old asymptomatic man High-resolution CT scan Shows scattered bilateral areas of ground-glass attenuation associated with inter- and intralobular lines. 47 http://radiographics.rsna.org/content/23/6/1509/F11.expansion.html
48. Case 07 Methotrexate-induced NSIP in a 41-year-old woman with rheumatoid arthritis who presented with dyspnea and decreased diffusing capacity of the lungs for carbon monoxide (DLCO). 48 http://radiographics.rsna.org/content/23/6/1509/F12.expansion.html
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50. Reactive hyperplastic type II pneumonocytes(arrow)49 http://radiographics.rsna.org/content/23/6/1509/F13.expansion.html
51. Case 07 / Photomicrograph (original magnification, ×400; hematoxylin-eosin stain) of a specimen from lung biopsy Findings consistent with NSIP induced by the pulmonary toxic effects of Methotrexate. 50 http://radiographics.rsna.org/content/23/6/1509/F13.expansion.html
52. Case 08 / Amiodarone-induced NSIP in an 88-year-old man with severe dyspnea High-resolution CT scan shows bilateral diffuse ground-glass attenuation and inter- and intralobular lines. Note the traction bronchiectasis. 51 http://radiographics.rsna.org/content/23/6/1509/F14.expansion.html
53. Case 09 Bleomycin induced organizing pneumonia in a 44-year-old woman with Hodgkin lymphoma who presented with: A nonproductive cough Dyspnea Decreased DLCO 52
55. Case 09 / High-resolution CT/ Bleomycin inducedBOOP The diagnosis of was confirmed with transthoracic biopsy 54 http://radiographics.rsna.org/content/23/6/1509/F17.expansion.html
60. Case 10 /High-resolution CT scan/ Lipoid pneumonia The results of bronchoalveolar lavage and transbronchial biopsy were nondiagnostic 58 http://radiographics.rsna.org/content/23/6/1509/F19.expansion.html
61. Case 10 / Photomicrograph (original magnification, ×250; hematoxylin-eosin stain) of a specimen from open lung biopsy shows numerous lipid-laden macrophages that fill and distend the alveoli (arrow) and interstitium. 59 http://radiographics.rsna.org/content/23/6/1509/F20.expansion.html
62. Case 11 / Posteroanterior chest radiograph Shows a centrally located mass adjacent to an area of diffuse ground-glass opacity in the right upper lobe. Note the air trapping in the lung base. 60 http://radiographics.rsna.org/content/23/6/1509/F24.expansion.html
63. Case 11 / Posteroanterior chest radiograph CT scan shows typical crazy-paving surrounding the mass, which is perihilar. 61 http://radiographics.rsna.org/content/23/6/1509/F24.expansion.html
64. Case 11 / What diagnosis that do you expect? Adenocarcinoma BOOP. Lipoidpneumonia Diffuse pulmonary hemorrhage P carinii pneumonia 62 http://radiographics.rsna.org/content/23/6/1509/F24.expansion.html
65. Case 11 / What diagnosis that do you expect? Diffuse pulmonary hemorrhage BOOP. Lipoidpneumonia Adenocarcinoma P carinii pneumonia 63 http://radiographics.rsna.org/content/23/6/1509/F24.expansion.html
66. Case 11 / How do you explain the ground glass? Lymphangitic carcinomatosis surrounding the central mass Adenocarcinoma with surrounding pulmonary hemorrhage 64 http://radiographics.rsna.org/content/23/6/1509/F24.expansion.html
67. Case 11 / How do you explain the ground glass? Lymphangitic carcinomatosis surrounding the central mass Adenocarcinoma with surrounding pulmonary hemorrhage 65 http://radiographics.rsna.org/content/23/6/1509/F24.expansion.html