Clinical Snapshot

Crazy Paving Pattern

Dtsch Arztebl Int 2018; 115: 714. DOI: 10.3238/arztebl.2018.0714b

Lussi, C; Christ, M; Flömer, F


An 81-year-old woman was taken to the hospital because of the suspected diagnosis of community-acquired pneumonia. She had a respiratory rate of 35/min and an O2 saturation of 68% on room air. She had been taking amiodarone 200 mg/d for two years because of tachycardic atrial fibrillation, and her chest x-ray revealed an unusual opacification, leading us to suspect amiodarone-induced pneumonitis. High-resolution computed tomography of the chest showed the typical so-called crazy paving pattern (alveolar ground-glass opacification with a superimposed irregular reticular pattern). Cytological examination of a bronchial lavage specimen confirmed our working diagnosis (CD8+ lymphocytic alveolitis with foam-cell macrophages and mild alveolar hemorrhagic syndrome).

The most common presentation of amiodarone-induced pneumopathy is interstitial pneumonitis, with an incidence of 1–5%. Risk factors include a daily amiodarone dose above 400 mg, advanced age, treatment for more than 2 months, and a pre-existing pneumopathy. The clinical presentation includes dry cough and dyspnea in 75% of cases, fever and weight loss in 33%. Our patient was treated with methylprednisolone 60 mg/d for two weeks, discontinuation of amiodarone, and empirical antibiotic therapy, and her condition rapidly improved.

Dr. med. Cristina Lussi, Prof. Dr. med. Michael Christ, Notfallzentrum, Luzerner Kantonsspital, Schweiz,

Dr. med. Frank Flömer, Röntgeninstitut Luzern, Luzerner Kantonsspital, Schweiz

Conflict of interest statement: The authors state that they have no conflict of interest.

Translated from the original German by Ethan Taub, M.D.

Cite this as: Lussi C, Flömer F, Christ M: Crazy paving pattern. Dtsch Arztebl Int 2018; 115: 714b. DOI: 10.3238/arztebl.2018.0714b