Barium aspiration showing crazy-paving appearance on high-resolution computed tomography

Abstract

We encountered a case showing a crazy-paving appearance on high-resolution computed tomography (HRCT), which mimicked various pulmonary diseases, e.g. pulmonary alveolar proteinosis, or non-specific interstitial pneumonia, but which we ultimately determined to be due to barium aspiration. The initial radiological findings were considered to be most likely due to pulmonary alveolar microlithiasis, because the crazy-paving appearance had high density, resembling calcification. However, distribution was limited to the area of dependent drainage of the right lung. Since a barium swallowing study had been performed 2 weeks before the CT examination, and since the follow-up HRCT showed improvement we reached a diagnosis of barium aspiration. Although barium aspiration may yield findings similar to other diseases with crazy-paving appearance, it is possible to identify it because of the limited distribution and high density.