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Review on Imaging Features for COVID-19
Published in S. Prabha, P. Karthikeyan, K. Kamalanand, N. Selvaganesan, Computational Modelling and Imaging for SARS-CoV-2 and COVID-19, 2021
In severe cases, more and more fluid fills the lobes of the lungs. Finally, the GGO’s appearance will be a solid white “consolidation” (Figure 2.10) (https://github.com/ieee8023/covid-chestxray-dataset/blob/master/). Final stages of COVID-19 reveal a crazy-paving pattern. Crazy paving means, there are thickened intralobular and interlobular lines in the GGO pattern. This pattern occurs in a later stage and is identified by inflammation of the interstitial space along with the walls of the lung lobules. This makes the walls heavier and thicker with white lines against the hazy GGO background. It looks like irregularly-shaped stones used to pave a street. Hence it is called crazy paving. Totally, there are three stages of CT findings: GGO; consolidation; and crazy-paving patterns. The combination of all three helps diagnose COVID-19 using imaging (Figure 2.11).
Using thoracic imaging to diagnose ILD
Published in Muhunthan Thillai, David R Moller, Keith C Meyer, Clinical Handbook of Interstitial Lung Disease, 2017
Maria Daniela Martin, Jeffrey P Kanne
Causes of crazy-paving include Infection (Pneumocystis, viral, Mycoplasma, and bacterial)OedemaHaemorrhageDiffuse alveolar damageOrganizing pneumoniaLipoid pneumoniaSarcoidosisPulmonary alveolar proteinosis (primary or secondary)Neoplasm (adenocarcinoma or lymphoma)Radiation-induced injury
Test Paper 7
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
Alveolar proteinosis is a rare disorder that is characterised by the abnormal accumulation of proteinaceous material in alveoli, secondary to altered surfactant homeostasis. It affects young to middle-aged adults and is more common in men. There is a strong association with cigarette smoking. Clinical features are variable, with symptoms usually being of gradual onset. Chest radiography typically demonstrates bilateral air-space opacity with either an ill-defined nodular or ground-glass pattern. An important discriminator from pulmonary oedema is the presence of perihilar lung changes in the absence of cardiomegaly, pulmonary venous hypertension and pleural effusions. Similarly, while sarcoidosis can mimic many lung conditions, the absence of lymphadenopathy is an important feature to note in alveolar proteinosis. The classic computed tomography finding is known as crazy paving – the description given to the combination of patchy ground-glass opacities with smooth interlobular septal thickening in a geographical distribution.
Autoimmune pulmonary alveolar proteinosis in an adolescent girl with rapidly progressive dyspnea
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2023
What is the differential diagnosis for a patient with progressive dyspnea and “crazy paving pattern” on CT scan?The differential diagnosis includes the broad categories of infection, malignancy, inhalation/aspiration disease, idiopathic pneumoniae, congestive heart failure, and autoimmune/inflammatory (Figure 3).What is the diagnostic approach and management of autoimmune PAP?Initial clinical assessment and blood tests may be normal. CXR may be abnormal but frequently shows nonspecific findings. Chest CT scan will often show a “crazy-paving” pattern. BAL may demonstrate a milky-white fluid macroscopically, which microscopically can have alveolar macrophages containing amorphous granular material that will stain positive with Periodic Acid Schiff (PAS) staining. Lung biopsy may be needed to confirm this if the BAL is not conclusive. However, there is improving availability and utility of blood testing of the GM-CSF pathway, receptors, and autoantibodies, which may increasingly help to avoid invasive testing.
Dandelion and focal crazy paving signs: the lung CT based predictors for evaluation of the severity of coronavirus disease
Published in Current Medical Research and Opinion, 2021
Xi Zhan, Zhihai Chen, Huijuan Hu, Yibin Yang, Kaisong Wu, Zhenshun Cheng, Bing Liu
The focal crazy paving sign was named to distinguish it from the classic crazy paving pattern. A crazy paving pattern is not a specific sign but it does present in many different pulmonary diseases such as pulmonary alveolar proteinosis (PAP), pulmonary edema, lipoid pneumonia, Pneumocystis jiroveci pneumonia27 and in cytomegalovirus pneumonia28, another type of viral infection that often affects immunocompromised individuals. It is expected that a relatively specific chest CT sign will be detected that indicates the presence of COVID-19, and in this study we used the term “focal crazy paving” sign for this indicator, which was observed more often in the patients with mild pneumonia compared to those with severe pneumonia in our cohort. Therefore, the focal crazy paving sign might indicate a mild form of the disease. More studies are needed to test the feasibility and specificity of this chest CT sign.
Evaluation of a comprehensive pre-procedural screening protocol for COVID-19 in times of a high SARS CoV-2 prevalence: a prospective cross-sectional study
Published in Annals of Medicine, 2021
Björn Stessel, Ina Callebaut, Fréderic Polus, Laurien Geebelen, Stefan Evers, Jean-Paul Ory, Koen Magerman, Geert Souverijns, Geert Braeken, Dirk Ramaekers, Janneke Cox
Screening of all patients for COVID-19 at the ambulant pre-procedural consultation facility in the Jessa Hospital2 days before the planned semi-urgentprocedure or therapy was instituted on April 13th. The screening includedthree different screening instruments. First, nasopharyngeal swabs were analysed with an in-house developed reverse-transcriptase PCR for the E-gene on the ARIES analyser (Luminex Corporation) in accordance with the World Health Organisation (WHO) protocol [9]. Second, a chest CT was performed to investigate four different radiologic signs suspect for COVID-19:1. the presence of a crazy-paving pattern (yes or no), 2. the presence of ground-glass opacity (GGO)(yes or no, if yes: peripheral GGO and/or central GGO yes or no), 3. consolidation(yes or no), and 4. the number of infected lobes was assessed. In addition, the presence of pleura fluid enlarged lymph nodes, and masses in the lungs was also evaluated. Third, patients were asked to complete a baseline questionnaire to assess baseline characteristics including gender, age, BMI, smoking behaviour, living area, current working situation, highest degree, medical history, use of medication, the presence of housemates with similar symptoms, and possible contact with confirmed COVID-19 positives together with the presence of clinical symptoms associated with COVID-19 at the date of screening. These symptoms were fever, myalgia, cough, sputum production, sore throat, anorexia, dyspnoea, rhinorrhoea, headache, anosmia, vomiting, and diarrhoea.