title: 'Crazy-paving' pattern: an exceptional presentation of cryptogenic organising pneumonia associated with chronic obstructive pulmonary disease.
abstract: Organising pneumonia (OP) is a distinct but uncommon entity with characteristic clinicoradiological features and histological findings. When the aetiology of OP remains unknown, it is termed as cryptogenic OP (COP). COP is seen in the majority of patients with OP and usually observed in non/former smokers. A 54-year-old man, a smoker, presented with breathlessness, cough and mucoid sputum. Imaging demonstrated unilateral 'Crazy-paving' pattern in the left upper lobe and left-sided effusion. In addition, paraseptal emphysema and left lower lobe bullae along with very severe obstructive ventilatory defect and impaired diffusion suggested chronic obstructive pulmonary disease (COPD). Transbronchial biopsy was suggestive of OP. In the absence of a definite aetiology, a diagnosis of COP associated with COPD was established. COP presenting as a unilateral 'Crazy-paving' pattern is yet to be documented. To the best of our knowledge, this is the first detailed description of COP presenting as unilateral 'Crazy-paving' pattern associated with COPD.
authors.affiliation: Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
authors.forename: Shekhar
authors.initials: S
authors.lastname: Kunal
authors.affiliation: Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Pilaniya
authors.affiliation: Department of Pathology, Oncquest Lab, New Delhi, India.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Jain
authors.affiliation: Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
authors.forename: Ashok
authors.initials: A
authors.lastname: Shah
mesh_terms: D058666:Adrenergic beta-2 Receptor Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D018549:Cryptogenic Organizing Pneumonia / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008400:Mass Chest X-Ray; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D018727:Muscarinic Antagonists; D011239:Prednisolone