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

• Published in: Korean journal of radiology Vol. 10; no. 1; pp. 21 - 24
• Main Authors: Marchiori, Edson, Escuissato, Dante L, Gasparetto, Taisa Davaus, Considera, Daniela Peixoto, Franquet, Tomas
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Radiology 01.01.2009; 대한영상의학회
• Subjects: Adenoviruses; Adolescent; Adult; Autopsies; Consolidation; Cytomegalovirus; Edema; Female; Hematopoietic Stem Cell Transplantation - adverse effects; Hemorrhage; Humans; Infections; Laboratories; Lavage; Lung - diagnostic imaging; Lung Diseases - diagnostic imaging; Lung Diseases - etiology; Lungs; Male; Medical imaging; Middle Aged; Morbidity; Mortality; Neutropenia; Original; Pathogens; Patients; Pleural effusion; Pneumonia; Pneumonia - diagnostic imaging; Pneumonia - etiology; Pulmonary Edema - diagnostic imaging; Pulmonary Edema - etiology; Respiratory distress syndrome; Respiratory syncytial virus; Respiratory Tract Infections - diagnostic imaging; Respiratory Tract Infections - etiology; Sarcoidosis; Stem cell transplantation; Tomography, X-Ray Computed; Young Adult; 방사선과학
• ISSN: 1229-6929; 2005-8330
• DOI: 10.3348/kjr.2009.10.1.21

To describe the pulmonary complications following hematopoietic stem cell transplantation (HSCT) that can present with a "crazy-paving" pattern in high-resolution CT scans. 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. 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%). The "crazy-paving" pattern is rare in HSCT recipients with pulmonary complications and is associated with infectious complications more commonly than non-infectious conditions.