A 73-year-old woman with an insidious onset of unexplained and progressive dyspnoea. Acute respiratory distress syndrome. CT revealed bilateral areas with ground-glass attenuation superimposed with a reticular pattern. These lines corresponded to thickening of the interlobular septa, but also thickening of the intralobular interstitium A chest radiograph and CT were undertaken. The chest radiograph showed a pleural effusion in the right hemothorax. An increased reticular pattern was seen in the left upper lung field and to a lesser degree also in the right upper lung field (Fig. 8a ). CT showed a diffuse crazypaving pattern with areas of ground-glass attenuation and thickening of the interlobular septa. There were also some small nodular lesions visible, mostly in the left upper lobe, suggestive of pulmonary metastases (Fig. 8b) .