“Crazy-Paving” Patterns on High-Resolution CT Scans in Patients with Pulmonary Complications after Hematopoietic Stem Cell Transplantation

Abstract

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 interlobu lar 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 toxo plasmosis), and three patients presented with non-infectious complications (idio pathic 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 pul monary complications and is associated with infectious complications more com monly than non-infectious conditions.