CASE 106

Unenhanced chest CT axial (Figs. 106.1A, 106.1B, 106.1C, 106.1D; lung window) and coronal (Figs. 106.1E; lung window) images demonstrate bilateral symmetric ground glass and smooth reticular opacities diffusely throughout the lungs without a zonal predilection. The involved regions of lung parenchyma are sharply demarcated from adjacent normal lung. This combination of ground glass with reticular opacities creates a pattern of disease called “crazy paving.” Note the preservation of lung volume and the absence of lymphadenopathy and pleural effusion.

Diagnosis

Pulmonary Alveolar Proteinosis

Differential Diagnosis

• Edema

Cardiogenic

ARDS

Acute Interstitial Pneumonia (AIP)

• Infection

Pneumocystis jiroveci Pneumonia

Viral Pneumonia

Mycoplasma Pneumonia

Bacterial Pneumonia

• Organizing Pneumonia

Bronchiolitis Obliterans Organizing Pneumonia (BOOP)/Cryptogenic Organizing Pneumonia (COP)

• Neoplasia

Adenocarcinoma in-situ

• Other

Hemorrhage

Pulmonary Alveolar Proteinosis

Sarcoidosis

Non-Specific Interstitial Pneumonia (NSIP)

Lipoid Pneumonia

Subacute Radiation Therapy–Related Pneumonitis (XRT)

Discussion

Background

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