"Crazy-paving" patterns on high-resolution CT scans in patients with pulmonary complications after hematopoietic stem cell transplantation

Korean J Radiol. 2009 Jan-Feb;10(1):21-4. doi: 10.3348/kjr.2009.10.1.21.


Objective: To describe the pulmonary complications following hematopoietic stem cell transplantation (HSCT) that can present with a "crazy-paving" pattern in high-resolution CT scans.

Materials and methods: Retrospective review of medical records from 2,537 patients who underwent HSCT. The "crazy-paving" pattern consists of interlobular and intralobular septal thickening superimposed on an area of ground-glass attenuation on high-resolution CT scans. The CT scans were retrospectively reviewed by two radiologists, who reached final decisions by consensus.

Results: We identified 10 cases (2.02%), seven male and three female, with pulmonary complications following HSCT that presented with the "crazy-paving" pattern. Seven (70%) patients had infectious pneumonia (adenovirus, herpes simplex, influenza virus, cytomegalovirus, respiratory syncytial virus, and toxoplasmosis), and three patients presented with non-infectious complications (idiopathic pneumonia syndrome and acute pulmonary edema). The "crazy-paving" pattern was bilateral in all cases, with diffuse distribution in nine patients (90%), predominantly in the middle and inferior lung regions in seven patients (70%), and involving the anterior and posterior regions of the lungs in nine patients (90%).

Conclusion: The "crazy-paving" pattern is rare in HSCT recipients with pulmonary complications and is associated with infectious complications more commonly than non-infectious conditions.

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Lung / diagnostic imaging*
  • Lung Diseases / diagnostic imaging*
  • Lung Diseases / etiology
  • Male
  • Middle Aged
  • Pneumonia / diagnostic imaging
  • Pneumonia / etiology
  • Pulmonary Edema / diagnostic imaging
  • Pulmonary Edema / etiology
  • Respiratory Tract Infections / diagnostic imaging
  • Respiratory Tract Infections / etiology
  • Tomography, X-Ray Computed*
  • Young Adult