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


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%).


CONCLUSIONS
The "crazy-paving" pattern is rare in HSCT recipients with pulmonary complications and is associated with infectious complications more commonly than non-infectious conditions.
Marchiori
Edson
E
Department of Radiology of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. edmarchiori@gmail.com
Escuissato
Dante L
DL
Gasparetto
Taisa Davaus
TD
Considera
Daniela Peixoto
DP
Franquet
Tomas
T
D000293:Adolescent; D000328:Adult; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000000981:diagnostic imaging / Q000209:etiology; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000209:etiology; D012141:Respiratory Tract Infections / Q000000981:diagnostic imaging / Q000209:etiology; D014057:Tomography, X-Ray Computed; D055815:Young Adult