대한흉부영상의학회 Weekly Chest Cases

Case No : 279 Date 2003-03-01

Courtesy of Hyae Young Kim, M.D. / National Cancer Center, Goyang-si, Kyeonggi-do, Korea
Age/Sex 58 / M
Chief ComplaintMild Dyspnea

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Diagnosis With Brief Discussion

Diagnosis: Adenocarcinoma
Radiologic Findings: Thin-section CT images show geographic areas of ground glass opacity with superimposed line densities, so called 'Crazy-Paving Pattern', in both lower lobes and right middle lobe. Poorly defined nodules with ground glass opacity are also seen. Assoicated finding is the presence of bizarre air cavity in right lower lobe.
PCNA was done for right middle lobe lesion. Biopsy revealed adenocarcinoma with BAC differentiation.
Brief Review: Ground-glass opacity superimposed on reticular pattern results in an appearance termed “crazy-paving” on HRCT. Ground-glass opacity may reflect the presence of airspace or interstitial abnormalities; the reticular opacities may represent interlobular septal thickening, thickening of the intralobular interstitium, irregular area of fibrosis, or a preponderance of an airspace-filling process at the periphery of lobules or acini. Although this pattern is quite typical of pulmonary alveolar proteinosis, it may also be seen in patients with a variety of other diseases.
The differential diagnosis of crazy-paving includes PAP; pulmonary edema; pulmonary hemorrhage; ARDS; AIP; diffuse alveolar damage; Pneumonias due to P. Carinii, virus, mycoplasma, bacteria and tuberculosis; BOOP, CEP, AEP, Eosinophilic lung disease; BAC; and lipoid pneumonia. The differential diagnosis of a cazy-paving pattern should be based on clinical and HRCT findings.
In patients with diffuse adenocarcinoma / BAC, the symptom is subacute or chronic. The HRCT finding is diffuse, patchy or centrilobular ground-glass opacity with reticular opacities (crazy-paving) and consolidation is common.
References: 1. Johkoh T, Itoh H, Muller NL, et al. Crazy-paving apperance at thin-section CT: spectrum of disease and pathologic findings. radiology 1999;211:155-160.
2. Webb WR, Muller NL, Naidich DP. High-resolution computed tomography findings of the lung diseases. In: 3rd ed. High-Resolution CT of the Lung. Philadelphia: Lippincott Williams, 2001;133-134.
Keywords: Lung, Malignant tumor,

No. of Applicants : 29

▶ Correct Answer : 4/29, 13.8%

- CHU Nancy-Brabois, France Denis Regent
- National Taiwan University Hospital, Taiwan Kao-Lang Liu
- Sarang Hospital, Incheon, Korea Jung Hee Kim
- Sunlin Hospital. Pohang, Korea Won Hyuk Shin

▶ Semi-Correct Answer : 25/29, 86.2%

- Annecy Hospital, France Gilles Genin
- Asan Medical Center, Korea Eun Jin Chae
- Bharat Scans, Chennai, India R G Gopinath
- CHU Grenoble, France Mathieu Rodiere
- Chung Li Ten-Chen Hospital, Taiwan Gui-Lin Zheng
- Chungju Hospital Konkuk University, Korea Chang Hee Lee
- Ewha Womans' University Hospital, Korea Sung Shine Shim
- Ewha Womans' University, Mokdong Hospital, KoreaYookyung Kim
- GeumGang Asan Hospital, Korea Ju Youn Park
- Gwangmoung Seongae Hospital, Korea Jiyong Rhee
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Hanyang University Hospital, Korea Seunghun Lee
- Inha university hospital, Korea Dong-Jae Shim
- Korea University Hospital, Korea Bo Kyung Je
- Maimonides Medical Center, New York, USA Naomi Twersky
- MH(CTC), Pune, India Vivek Sharma
- Ospedale di Jesi, Italy Giancarlo Passarini
- Prever-Centro Radiologico, Brazil Arismar Leon Pereira
- Samsung Medical Center, Korea Chin A Yi
- Seoul National University Hospital, Korea Kyung Soo Cho
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- SUN Hospital, Korea Ki Taek Hong
- Teleradiology Solutions, Bangalore, India Sharad Bidari
- Tokyo Kouseinenkin Hospital , Japan Noriatsu Ichiba
- Ulsan University Hospital, Korea Kwang-Won Seo

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 279 Date 2003-03-01

Discussion

No. of Applicants : 29