CASE:
A 69-year-old female non-smoker presented with prolonged coughing with
haemoptysis, loss of weight and loss of appetite. The initial CT scan
revealed a heterogeneous mass in the lower lobe of the right lung with
surrounding ‘crazy paving’ appearance (Figure 1A). The CT-guided biopsy
revealed invasive moderately differentiated adenocarcinoma (eGFR
positive) of the lung. She also developed right humeral pathological
fracture secondary to bone metastasis. Her disease initially showed some
improvement with Gefitinib, but progressed 6-months later. A repeat CT
scan showed the whole aforementioned area of crazy paving appearance was
completely replaced by solid tumour, confirming that the ‘crazy paving’
was tumour infiltration (Figure 1B).
Lung carcinoma usually appears as nodule (solid or subsolid) or mass on
CT.1 Rarely, they may appear as ground glass opacity
or consolidation.1 For lung carcinoma to demonstrate
crazy paving as the CT appearances is rare despite its recognized
existence and is usually caused by adenocarcinoma. Demonstration of
crazy paving surrounding a sizable solid component of lung
adenocarcinoma is even rarer. For lesion with solid and crazy paving
changes, the solid component likely represent invasive portion of the
neoplasm, whereas, the peripheral ‘crazy paving’ opacity may represent
areas of lepidic growth.