Dry Cough and ‘Crazy Paving’ on CT

A 28-year-old woman with a chronic dry cough. CT shows a ‘crazy paving’ pattern and Biopsy reveals noncaseating granulomas. What’s the diagnosis?

Pulmonary Sarcoidosis


A 28-year-old woman presented to the hospital with a 6-month history of dry cough. She was a lifetime nonsmoker and reported no fevers, joint aches, eye pain, or rashes. On physical examination, auscultation of both lower lungs revealed fine crackles. High-resolution computed tomography (CT) of the chest showed mediastinal lymphadenopathy and diffuse ground-glass opacities (left, axial view). Also visible were areas of superimposed interlobular and intralobular septal thickening, a pattern known as crazy paving (left, box). A subsequent transbronchial lung biopsy showed multiple noncaseating granulomas (middle, inset showing granuloma; hematoxylin and eosin stain). Bronchoalveolar lavage cultures, histopathological analysis, and molecular testing were negative for infectious organisms, including Mycobacterium tuberculosis. Which of the following is the most likely diagnosis?

What is the most likely diagnosis?

Foreign body granulomatosis
Granulomatosis with polyangiitis
Pulmonary alveolar proteinosis
Pulmonary Langerhans cell histiocytosis
Pulmonary Sarcoidosis

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