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3. The “crazy paving” pattern
The “crazy paving” pattern on CT consists of multifocal ground-glass opacity with superimposed interlobular septal thickening and intralobular lines, typically with a sharp, geographic, non-anatomic demarcation between normal and abnormal lung. The pattern is named for a resemblance to irregularly shaped paving stones (Figure 3).
Figure 3. “Crazy paving”- tile mosaic illustrating the genesis of the use of this term for describing a specific pattern of geographic, heterogeneous lung opacity encountered at HRCT.
The “CT angiogram sign” represents enhancing pulmonary vessels within a homogeneous area of lung consolidation. The CT angiogram sign was original described as suggestive of bronchoalveolar carcinoma, but is now recognized as nonspecific, and may be encountered in a number is disparate conditions. The “cervicothoracic sign” is a radiographic sign that describes the appearance of a lesion located at the thoracic inlet. Because the posterior lung extends more superiorly than the anterior lung at the thoracic inlet, the “cervicothoracic sign” indicates that a mediastinal lesion whose border is clearly visible cranial to the clavicles on a frontal chest radiograph must lie posteriorly. The “Hampton hump” sign represents a subpleural, triangular- or wedge-shaped opacity with a rounded or truncated apex directed towards the pulmonary hilum, typical of pulmonary infarction in the setting of venous thromboembolism. The “feeding vessel” sign at thoracic CT represents a pulmonary vessel that leads directly into a pulmonary nodule or mass. This sign reflects the “angiocentricity” of a lesion, and is therefore often encountered in lesions hematogenously disseminated to the lungs, such as metastatic disease, miliary infections, arteriovenous malformations, and septic emboli.)
What is the appropriate next step for the evaluation / management of this patient?