Cover Image

Adenocarcinoma insitu presenting as extensive crazy paving pattern: HRCT findings and review of literature

Rahul Dev, Pankaj Sharma, Yasrab Khan


The crazy-paving pattern seen on HRCT is comprised of diffuse areas of ground glass attenuation. This imaging finding has numerous differentials including idiopathic, infectious, neoplastic and other miscellaneous entities. A 52-year-old non-smoker presented with mild to moderate dyspnoea with occasional cough and restrictive pattern on PFT. Chest radiograph showed bilateral diffuse air space opacities with crazy paving pattern on High resolution CT of the lung. This pattern has numerous differentials with pattern of lung involvement, the patient’s history and clinical findings being helpful in narrowing the diagnosis.

Full Text:



Gardiner N, Jogai S, Wallis A. The revised lung adenocarcinoma classification-an imaging guide. J Thorac Dis. 2014 Oct; 6 (Suppl 5): S537-46. doi: 10. 3978 /j. issn. 2072-1439.2014.04.05.

Lee CH. The crazy-paving sign. Radiology. 2007 Jun; 243(3):905-6. doi:10.1148/radiol.2433041835.

Maimon N, Heimer D. The crazy-paving pattern on computed tomography. CMAJ. 2010 Oct 5; 182 (14): 1545. doi: 10.1503/cmaj.091422. Epub 2010 Jun 14.

Johkoh T, Itoh H, Müller NL, et al. Crazy-paving appearance at thin-section CT: spectrum of disease and pathologic findings. Radiology. 1999 Apr; 211 (1):155-60. doi:10. 1148 /radiology. 211. 1. r99 ap10155.

Trigaux JP, Gevenois PA, Goncette L, et al. Bronchi-oloalveolar carcinoma: computed tomography findings. Eur Respir J. 1996 Jan;9(1):11-6.

Patsios D, Roberts HC, Paul NS, et al. Pictorial review of the many faces of bronchioloalveolar cell carcinoma. Br J Radiol. 2007 Dec; 80 (960):1015-23. Epub 2007 Oct 16.doi:10.1259/bjr/52225107.

Lee KS, Kim Y, Han J, et al. Bronchioloalveolar carcinoma: clinical, histopathologic, and radiologic findings. Radiographics. 1997 Nov-Dec; 17 (6):1345-57. doi:10.1148/radiographics.17.6.9397450.

Yousem SA, Beasley MB. Bronchioloalveolar carcinoma: a review of current concepts and evolving issues.ArchPatholLabMed.2007Jul;131(7):1027-32. doi: 10.1043/15432165(2007)131[1027:BCAROC]2.0.CO;2

de Perrot M, Chernenko S, Waddell TK, et al. Role of lung transplantation in the treatment of bronchogenic carcinomas for patients with end-stage pulmonary disease. J Clin Oncol. 2004 Nov 1; 22 (21):4351-6.doi: 10. 1200/JCO.2004.12.188.


  • There are currently no refbacks.