DOCSLIB.ORG

Practitioners' Section

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Practitioners' Section 474 PRACTITIONERS’ SECTION LIPOID PNEUMONIA: AN UNCOMMON ENTITY G. C. KHILNANI, V. HADDA ABSTRACT Lipoid pneumonia is a rare form of pneumonia caused by inhalation or aspiration of fat-containing substances like petroleum jelly, mineral oils, certain laxatives, etc. It usually presents as an insidious onset, chronic respiratory illness simulating interstitial lung diseases. Rarely, it may present as an acute respiratory illness, especially when the exposure to fatty substance(s) is massive. Radiological findings are diverse and can mimic many other diseases including carcinoma, acute or chronic pneumonia, ARDS, or a localized granuloma. Pathologically it is a chronic foreign body reaction characterized by lipid-laden macrophages. Diagnosis of this disease is often missed as it is usually not considered in the differential diagnoses of community-acquired pneumonia; it requires a high degree of suspicion. In suspected cases, diagnosis may be confirmed by demonstrating the presence of lipid-laden macrophages in sputum, bronchoalveolar lavage fluid, or fine needle aspiration cytology/biopsy from the lung lesion. Treatment of this illness is poorly defined and constitutes supportive therapy, repeated bronchoalveolar lavage, and corticosteroids. Key words: Lipid-laden macrophages, lipoid pneumonia, mineral oil aspiration DOI: 10.4103/0019-5359.57639 PMID: 19901490 INTRODUCTION like parafÞ noma, cholesterol pneumonia, lipid granulomatosis, all denoting its association Lipoid pneumonia (LP) is a rare form of with the inhalation or ingestion of various pneumonia caused by inhalation or aspiration substances like petroleum jelly, mineral oils, of a fatty substance. It was Þ rst described in “nasal drops,” and even intravenous injection of 1925 by Laughlin and later by others in the olive oil.[5-13] Many of us are unfamiliar with this Þ rst half of the twentieth century.[1-4] Since then, condition, a fact that may be responsible for the there are many reports with different names underdiagnosis of LP. This entity does not have characteristic clinical or radiological features, Department of Medicine, All India Institute of Medical which makes its diagnosis difÞ cult, unless it is Sciences, New Delhi-110 029, India. already suspected. Therefore, awareness of Correspondence: this type of pneumonia is important. Making Dr. G.C. Khilnani Department of Medicine, a diagnosis of LP requires a high degree of All India Institute of Medical Sciences, clinical suspicion. It should be considered in New Delhi-110 029, India. E-mail: [email protected] the differential diagnoses of many pulmonary Indian J Med Sci, Vol. 63, No. 10, October 2009 LIPOID PNEUMONIA 475 conditions, especially in cases with history of The usual presentation of LP is an insidious exposure to fatty substances. Importantly, if onset of dyspnea and/or cough, similar to those diagnosed in a timely manner, the progression of other chronic lung diseases. Less commonly may be halted or at least slowed by stopping described clinical features include chest pain, the exposure to the offending agent. Once hemoptysis, and intermittent fever which may suspected, diagnosis can be established by be related to the inß ammatory reaction to oil, demonstrating the presence of lipid-laden or which may be secondary to infection.[22] macrophages in various specimens such as Systemic symptoms are uncommon unless sputum, bronchoalveolar lavage, and lung chronic hypoxia precipitates weight loss due to biopsy. The aim of this review is to increase chronically increased work of breathing. Physical awareness of this uncommon entity among examination Þ ndings may be unremarkable or physicians. there may be dullness detected on percussion, crackles, wheezes, or rhonchi. With progressive, CLINICAL FEATURES longstanding disease, physical Þ ndings related to chronic hypoxia can develop. Pulmonary Lipoid pneumonia is an unusual cause of function tests results have shown a restrictive respiratory symptoms and has been reported pattern but they may also be normal.[22,23] Acute in all age groups. Initial reports of LP presentation simulating infectious pneumonia predominantly included children, often with with fever, with or without cough, is unusual.[24] local anatomic defects like cleft palate, or However, acute presentation with respiratory debilitated adults, but several reports indicate failure has been reported with accidental/ that it can occur in healthy individuals as suicidal massive exposure to mineral oil but not well.[8,14] There are reports of LP associated with submassive exposure or inhalation and in with aspirating or inhaling mineral oil, oil-based children.[25-28] Laboratory test results are usually laxatives, lip balm, lip glow etc.[15,16] Siphoning of normal although leukocytosis and an increased various mineral oils (like diesel) from containers erythrocyte sedimentation rate may occur, is a common practice in India and may be an especially when complicated by infection. important risk factor for LP. Other risk factors RADIOLOGICAL FEATURES described in infants and small children are the use of traditional folk remedies like the use of oily Chest X-ray Þ ndings are diverse and can mimic nasal drops, forceful feeding of animal fats such many other diseases including carcinoma, as “ghee” to establish regular bowel habits, or acute or chronic pneumonia, ARDS, or a transnasal use to treat cough and cold.[17,18] Other localized granuloma.[29-31] A homogenous dense common examples of risk factors for LP are the consolidation, often with air bronchograms, and use of sesame oil to ß ush nasal secretions (in sometimes a Þ ne, “spun glass” appearance may India) and to relieve small bowel obstruction due be appreciated in early disease.[29] Involvement to Ascaris lumbricoides (in Brazil).[19,20] It has also may be diffuse or focal, unilateral or bilateral, been reported after bronchography due to the although unilateral pneumonic consolidation use of dye propyliodone (now rarely performed) with lower lobes predilection is more commonly and nasogastric tube feeding.[21] reported.[29,30,32,33] Occasionally, one may also Indian J Med Sci, Vol. 63, No. 10, October 2009 476 INDIAN JOURNAL OF MEDICAL SCIENCES Þ nd cavitation.[34,35] A reticular pattern may be oil. Mineral oils enter the tracheobronchial observed as the emulsiÞ ed oil leaves the alveoli tree without stimulating cough reflex and and enters the interstitium and lymphatics, impair the mucociliary transport system. creating edema, inß ammation, and Þ brosis in Therefore, once inside the alveoli, it is difÞ cult those sites. Fibrosis and coalescence of oil to expectorate the lipid out. This situation can result in nodules and masses with irregular may be complicated by some associated margins, closely mimicking lung cancer.[29,30] neurological and gastrointestinal disorders Atelectasis and pleural effusion have also that affect swallowing and the palatal or cough been described.[22,32,34] CT scan and magnetic reß ex. Once in the alveoli, oil is taken up by resonance imaging can detect fat within macrophages after emulsiÞ cation and because pulmonary tissue. The most commonly described alveolar macrophages cannot metabolize the features are alveolar consolidations [Figures 1a fatty substance, the oil is repeatedly released and b] of low attenuation values (-30 to -150 into the alveoli after the death of the HU), ground glass opacities with thickening macrophages.[43] The oil thus released illicits of intralobular septa (crazy paving pattern), or a giant cell granulomatous reaction (hence, alveolar nodules.[17,36-38] Magnetic resonance LP is also called lipid granulomatosis), chronic imaging may reveal high signal intensity on T1- inflammation, and alveolar and interstitial weighted imaging that is consistent with lipid fibrosis. Evolution of the lesions with time content.[38-42] Lower lobe predominance of the has been described.[41] Fresh lesions show radiographic Þ ndings are often described but not alveolar inÞ ltration by lipid-laden macrophages uniformly seen. and almost normal alveolar walls and septa. Advanced lesions show larger vacuoles PATHOPHYSIOLOGY and inflammatory infiltrates of the alveolar walls, bronchial walls, and septa. Fibrosis Pathologically, LP is a result of a chronic foreign and parenchymal destruction around large body reaction to inhaled/aspirated mineral lipid-containing vacuoles are features of the a b Figure 1: Noncontrast computerized tomographic images of young patients with lipoid pneumonia. Mediastinal, (a) and lung window, (b) showing consolidation in right middle lobe, lower lobe, and also left lung. Few low density areas (arrow) are seen within the middle lobe consolidation. (Reproduced with permission from Biomed Central and Cases Journal) Indian J Med Sci, Vol. 63, No. 10, October 2009 LIPOID PNEUMONIA 477 oldest lesions. Special staining techniques (oil the inflammatory response.[50] However, as red O, Sudan black etc) can more effectively corticosteroids are not to be used routinely, demonstrate that the vacuoles are lipid-Þ lled. The their use is only if the lung injury is severe and speciÞ c type of oil aspirated can be determined ongoing. Other treatment modalities described in by chemical analysis, spectroscopy, and literature are immunoglobins,[51] and whole lung chromatography.[44,45] lavage.[52,53] Repeated bronchoalveolar lavage (BAL) with saline has been shown to be an DIAGNOSIS effective therapeutic modality for the treatment of LP.[28] Some researchers successfully used Diagnosis of LP is
Load more

Recommended publications
  • Lipoid Pneumonia
    PRACA ORYGINALNA Piotr Buda1, Anna Wieteska-Klimczak1, Anna Własienko1, Agnieszka Mazur2, Jerzy Ziołkowski2, Joanna Jaworska2, Andrzej Kościesza3, Dorota Dunin-Wąsowicz4, Janusz Książyk1 1Department of Pediatrics, The Children’s Memorial Health Institute, Warsaw, Poland Head: Prof. J. Książyk, MD, PhD 2Department of of Pediatric Pneumonology and Allergology, Medical University of Warsaw, Poland Head: M. Kulus, MD, PhD 3Department of Radiology, CT unit, The Children’s Memorial Health Institute, Warsaw, Poland Head: E. Jurkiewicz MD, PhD 4Department of Neurology and Epileptology, The Children’s Memorial Health Institute, Warsaw, Poland Head: S. Jóźwiak, MD, PhD Lipoid pneumonia — a case of refractory pneumonia in a child treated with ketogenic diet Tłuszczowe zapalenie płuc u dziecka leczonego dietą ketogenną — przypadek kliniczny The Authors declare no financial disclosure. Abstract Lipoid pneumonia (LP) is a chronic inflammation of the lung parenchyma with interstitial involvement due to the accu mulation of endoge- nous or exogenous lipids. Exogenous LP (ELP) is associated with the aspiration or inhalation of oil present in food, oil-based medications or radiographic contrast media. The clinical manifestations of LP range from asymptomatic cases to severe pulmonary involvement, with respiratory failure and death, according to the quantity and duration of the aspiration. The diagnosis of exogenous lipoid pneumonia is based on a history of exposure to oil and the presence of lipid-laden macrophages on sputum or bronchoalveolar lavage (BAL) analysis. High-resolution computed tomography (HRCT) is the imaging technique of choice for evaluation of patients with suspected LP. The best therapeutic strategy is to remove the oil as early as possible through bronchoscopy with multiple BALs and interruption in the use of mineral oil.
    [Show full text]
  • Journal Pre-Proof
    Journal Pre-proof Presenting Clinico-radiologic Features, Causes, and Clinical Course of Exogenous Lipoid Pneumonia in Adults Bilal F. Samhouri, MD, Yasmeen K. Tandon, MD, Thomas E. Hartman, MD, Yohei Harada, MD, Hiroshi Sekiguchi, MD, Eunhee S. Yi, MD, Jay H. Ryu, MD PII: S0012-3692(21)00433-5 DOI: https://doi.org/10.1016/j.chest.2021.02.037 Reference: CHEST 4063 To appear in: CHEST Received Date: 20 December 2020 Revised Date: 14 February 2021 Accepted Date: 16 February 2021 Please cite this article as: Samhouri BF, Tandon YK, Hartman TE, Harada Y, Sekiguchi H, Yi ES, Ryu JH, Presenting Clinico-radiologic Features, Causes, and Clinical Course of Exogenous Lipoid Pneumonia in Adults, CHEST (2021), doi: https://doi.org/10.1016/j.chest.2021.02.037. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Copyright © 2021 Published by Elsevier Inc under license from the American College of Chest Physicians. 1 Word count: abstract –283, text – 3,108 2 Title: Presenting Clinico-radiologic Features, Causes, and Clinical Course of Exogenous Lipoid 3 Pneumonia in Adults 4 Short title: Exogenous Lipoid Pneumonia 5 Author list: 6 Bilal F.
    [Show full text]
  • Task Force on Chronic Interstitial Lung Disease in Immunocompetent Children
    Copyright #ERS Journals Ltd 2004 Eur Respir J 2004; 24: 686–697 European Respiratory Journal DOI: 10.1183/09031936.04.00089803 ISSN 0903-1936 Printed in UK – all rights reserved ERS TASK FORCE Task force on chronic interstitial lung disease in immunocompetent children A. Clement*, and committee members Committee members: J. Allen, B. Corrin, R. Dinwiddie, H. Ducou le Pointe, E. Eber, G. Laurent, R. Marshall, F. Midulla, A.G. Nicholson, P. Pohunek, F. Ratjen, M. Spiteri, J. de Blic. All members of the Task Force contributed equally to the work. Task force on chronic interstitial lung disease in immunocompetent children. Correspondence: A. Clement, Dept de Pneumo- A. Clement, and committee members. #ERS Journals Ltd 2004. logie Pediatrique - INSERM E213, Hopital ABSTRACT: Chronic interstitial lung diseases in children represent a heterogeneous d9enfants Armand Trousseau, 26 Ave du group of disorders of both known and unknown causes that share common histological Dr Arnold Netter, 75571 Paris cedex 12, France. features. Despite many efforts these diseases continue to present clinical management Fax: 33 144736718 dilemmas, principally because of their rare frequency that limits considerably the E-mail: [email protected] possibilities of collecting enough cases for clinical and research studies. Through a Task Force conducted by the European Respiratory Society, which Keywords: Children, infant, interstitial lung comprised respiratory physicians and basic scientists from across Europe, 185 cases of disease, lung fibrosis interstitial lung diseases in immunocompetent children were collected and reviewed. The present report provides important clinically-relevant information on the current Received: August 5 2003 approach to diagnosis and management of chronic interstitial lung diseases in children.
    [Show full text]
  • Pathology of Allergic Bronchopulmonary Aspergillosis
    [Frontiers in Bioscience 8, e110-114, January 1, 2003] PATHOLOGY OF ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS Anne Chetty Department of Pediatrics, Floating Hospital for Children, New England Medical Center, Boston, MA TABLE OF CONTENTS 1. Abstract 2. Introduction 3. Immunopathogenesis 4. Pathologic Findings 4.1. Plastic bronchitis 4.2. Allergic fungal sinusitis 4.3. ABPA in cystic fibrosis 5. Acknowledgement 6. References 1. ABSTRACT Allergic bronchopulmonary aspergillosis (ABPA) individuals with episodic obstructive lung diseases such as occurs in patients with asthma and cystic fibrosis when asthma and cystic fibrosis that produce thick, tenacious Aspergillus fumigatus spores are inhaled and grow in sputum. bronchial mucus as hyphae. Chronic colonization of Aspergillus fumigatus and host’s genetically determined Decomposing organic matter serves as a substrate immunological response lead to ABPA. In most cases, for the growth of Aspergillus species. Because biologic lung biopsy is not necessary because the diagnosis is made heating produces temperatures as high as 65° to 70° C, on clinical, serologic, and roentgenographic findings. Some Aspergillus spores will not be recovered in the latter stages patients who have had lung biopsies or partial resections of composting. Aspergillus species have been recovered for atelectasis or infiltrates will have histologic diagnoses. from potting soil, mulches, decaying vegetation, and A number of different histologic diagnoses can be found sewage treatment facilities, as well as in outdoor air and even in the same patient. In the early stages the bronchial Aspergillus spores grow in excreta from birds (1) wall is infiltrated with mononuclear cells and eosinophils. Mucoid impaction and eosinophilic pneumonia are seen Allergic fungal pulmonary disease is manifested subsequently.
    [Show full text]
  • Exogenous Lipoid Pneumonia Complicated by Mineral Oil Aspiration in a Patient with Chronic Constipation: a Case Report and Review
    Open Access Case Report DOI: 10.7759/cureus.9294 Exogenous Lipoid Pneumonia Complicated by Mineral Oil Aspiration in a Patient With Chronic Constipation: A Case Report and Review Hafiz Muhammad Jeelani 1 , Muhammad Mubbashir Sheikh 2 , Belaal Sheikh 3, 4 , Hafiz Mahboob 5 , Anchit Bharat 6 1. Internal Medicine, Rosalind Franklin University of Medicine and Science, McHenry, USA 2. Oncology, Northwestern University Feinberg School of Medicine, Chicago, USA 3. Internal Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, USA 4. Internal Medicine, Chicago Medical School, North Chicago, USA 5. Pulmonary and Critical Care Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, USA 6. Internal Medicine, Indiana University Health Ball Memorial Hospital, Muncie, USA Corresponding author: Hafiz Muhammad Jeelani, [email protected] Abstract Exogenous lipoid pneumonia is a rare and frequently misdiagnosed lung disease. It occurs as an inflammatory reaction secondary to either aspiration or inhalation of lipids. Our patient had a history significant for recurrent pneumonia and the use of mineral oil for chronic constipation. A chest computed tomography showed multifocal consolidative opacities with areas of low attenuation, highly suspicious of exogenous lipid pneumonia. The diagnosis was confirmed with combined bronchoalveolar lavage and transbronchial lung biopsy that showed lipid-laden macrophages consistent with exogenous lipoid pneumonia. After thorough medication review, apart from mineral oil, no other contributing factors were found. A diagnosis of exogenous lipoid pneumonia associated with the use of mineral oil made and successfully managed by stopping the offending agent and supportive antibiotics. Categories: Internal Medicine, Medical Education, Pulmonology Keywords: lipoid pneumonia, mineral oil, constipation, bal lavage, macrophages Introduction Lipoid pneumonia has been identified as a non-infectious cause of recurrent aspiration pneumonia in 1- 2.5% cases.
    [Show full text]
  • PNEUMONIAS Pneumonia Is Defined As Acute Inflammation of the Lung
    PNEUMONIAS Pneumonia is defined as acute inflammation of the lung parenchyma distal to the terminal bronchioles which consist of the respiratory bronchiole, alveolar ducts, alveolar sacs and alveoli. The terms 'pneumonia' and 'pneumonitis' are often used synonymously for in- flammation of the lungs, while 'consolidation' (meaning solidification) is the term used for macroscopic and radiologic appearance of the lungs in pneumonia. PATHOGENESIS. The microorganisms gain entry into the lungs by one of the following four routes: 1. Inhalation of the microbes. 2. Aspiration of organisms. 3. Haematogenous spread from a distant focus. 4. Direct spread from an adjoining site of infection. Failure of defense me- chanisms and presence of certain predisposing factors result in pneumonias. These condi- tions are as under: 1. Altered consciousness. 2. Depressed cough and glottic reflexes. 3. Impaired mucociliary transport. 4. Impaired alveolar macrophage function. 5. Endo- bronchial obstruction. 6. Leucocyte dysfunctions. CLASSIFICATION. On the basis of the anatomic part of the lung parenchyma involved, pneumonias are traditionally classified into 3 main types: 1. Lobar pneumonia. 2. Bronchopneumonia (or Lobular pneumonia). 3. Interstitial pneumonia. A. BACTERIAL PNEUMONIA Bacterial infection of the lung parenchyma is the most common cause of pneumonia or consolidation of one or both the lungs. Two types of acute bacterial pneumonias are dis- tinguished—lobar pneumonia and broncho-lobular pneumonia, each with distinct etiologic agent and morphologic changes. 1. Lobar Pneumonia Lobar pneumonia is an acute bacterial infection of a part of a lobe, the entire lobe, or even two lobes of one or both the lungs. ETIOLOGY. Following types are described: 1.
    [Show full text]
  • High-Resolution Computed Tomography to Differentiate Chronic Diffuse
    Original article: Clinical research SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2016; 33; 355-371 © Mattioli 1885 High-resolution computed tomography to differentiate chronic diffuse infiltrative lung diseases with chronic multifocal consolidation patterns using logical analysis of data Constance de Margerie-Mellon1*, Geneviève Dion2*, Julien Darlay3, Imene Ridene4, Marianne Kambouchner5, Nadia Brauner3, Michel Brauner6, Dominique Valeyre7, Pierre-Yves Brillet6 1Department of Radiology, Hôpital Saint-Louis, Université Paris 7 Denis Diderot, Sorbonne Paris-Cité, Paris, France; 2 Department of Pneumology, Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada; 3 Labo- ratoire G-SCOP, Université Joseph Fourier, Grenoble, France; 4 Department of Radiology, Hôpital Abderrahmane Mami, Ariana, Tunisie; 5Department of Pathology, EA2363 Laboratory, Hôpital Avicenne, Université Paris 13, Sorbonne Paris Cité, Bobigny, France; 6 Department of Radiology, EA2363 Laboratory, Hôpital Avicenne, Université Paris 13, Sorbonne Paris Cité, Bobigny, France; 7Department of Pneumology, EA2363 Laboratory, Hôpital Avicenne, Université Paris 13, Sorbonne Paris Cité, Bobigny, France Abstract. Background: Chronic lung consolidation has a limited number of differential diagnoses requiring dis- tinct managements. The aim of the study was to investigate how logical analysis of data (LAD) can support their diagnosis at HRCT (high-resolution computed tomography). Methods: One hundred twenty-four patients were retrospectively included and classified into 8 diagnosis categories: sarcoidosis (n=35), connective tissue disease (n=21), adenocarcinoma (n=17), lymphoma (n=13), cryptogenic organizing pneumonia (n=11), drug-induced lung disease (n=9), chronic eosinophilic pneumonia (n =7) and miscellaneous (n=11). First, we investigated the patterns and models (association of patterns characterizing a disease) built-up by the LAD from combina- tions of HRCT attributes (n=51).
    [Show full text]
  • An Exotic Cause of Exogenous Lipoid Pneumonia
    Hindawi Publishing Corporation Case Reports in Pulmonology Volume 2016, Article ID 1035601, 5 pages http://dx.doi.org/10.1155/2016/1035601 Case Report Teppanyaki/Hibachi Pneumonitis: An Exotic Cause of Exogenous Lipoid Pneumonia Franck Rahaghi, Ali Varasteh, Roya Memarpour, and Basheer Tashtoush Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA Correspondence should be addressed to Franck Rahaghi; [email protected] Received 30 July 2016; Accepted 25 October 2016 Academic Editor: Fabio Midulla Copyright © 2016 Franck Rahaghi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Exogenous lipoid pneumonia (ELP) is a rare type of inflammatory lung disease caused by aspiration and/or inhalation of fatty substances and characterized by a chronic foreign body-type reaction to intra-alveolar lipid deposits. The usual clinical presentation occurs with insidious onset of nonspecific respiratory symptoms and radiographic findings that can mimic other pulmonary diseases. Diagnosis of ELP is often missed or delayed as it requires a high index of suspicion and familiarity with the constellation of appropriate history and radiologic and pathologic features. We herein report a case of occupational exposure to tabletop “Teppanyaki” entertainment cooking as a cause of ELP, confirmed by surgical lung biopsies in a 63-year-old Asian woman who worked as a Hibachi-Teppanyaki chef for 25 years. 1. Introduction 2. Case Presentation Lipoid pneumonia was first described by Laughlen in 1925, A 63-year-old Japanese woman was referred to the pul- in one adult, one infant, and two children after repeated monary clinic for evaluation of her interstitial lung disease inhalation of nasopharyngeal oil droplets [1].
    [Show full text]
  • Exogenous Lipoid Pneumonia Successfully Treated with Bronchoscopic Segmental Lavage Therapy
    Exogenous Lipoid Pneumonia Successfully Treated With Bronchoscopic Segmental Lavage Therapy Shota Nakashima MD, Yuji Ishimatsu MD PhD, Shintaro Hara MD PhD, Masanori Kitaichi MD PhD, and Shigeru Kohno MD PhD A 65-y-old Japanese man was referred to the respiratory medicine department because of abnormal radiologic findings. High-resolution chest computed tomography scans revealed a geographic dis- tribution of ground-glass opacities and associated thickening of the interlobular septa (crazy-paving patterns) in both lower lobes. He had a habit of drinking 400–500 mL of milk and 400–800 mL of canned coffee with milk every day. A swallowing function test revealed liquid dysphagia. Bron- choalveolar lavage fluid cytology findings showed multiple lipid-laden macrophages. Taken to- gether, these findings revealed exogenous lipoid pneumonia. We performed bronchoscopic segmen- tal lavage therapy 3 times in the left lung. After the treatment, the radiologic findings improved in both lungs. The patient has not experienced a recurrence of lipoid pneumonia in2ytodate. In conclusion, a case of exogenous lipoid pneumonia was successfully treated with bronchoscopic segmental lavage therapy. Key words: lipoid pneumonia; exogenous lipoid pneumonia; treatment; milk; bronchoscopic segmental lavage; multiple segmental bronchoalveolar lavages. [Respir Care 2015;60(1):e1–e5. © 2015 Daedalus Enterprises] Introduction Case Report Exogenous lipoid pneumonia is an uncommon form of A 65-y-old Japanese man was referred to the respiratory pneumonia that is related to the inhalation or aspiration of medicine department at our hospital because of abnormal fatty substances.1 Although there are reports of lipoid pneu- radiologic findings. He had undergone a left hepatic lo- monia being successfully treated with corticosteroids,2-4 bectomy 13 y prior because of hepatocellular carcinoma.
    [Show full text]
  • Exogenous Lipoid Pneumonia. Clinical and Radiological Manifestations
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Respiratory Medicine (2011) 105, 659e666 available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/rmed REVIEW Exogenous lipoid pneumonia. Clinical and radiological manifestations Edson Marchiori a,b,*, Gla´ucia Zanetti b,c, Claudia Mauro Mano a,d, Bruno Hochhegger b,e a Fluminense Federal University, Rio de Janeiro, Brazil b Federal University of Rio de Janeiro, Rio de Janeiro, Brazil Received 19 August 2010; accepted 1 December 2010 Available online 23 December 2010 KEYWORDS Summary Exogenous lipoid Lipoid pneumonia results from the pulmonary accumulation of endogenous or exogenous lipids. pneumonia; Host tissue reactions to the inhaled substances differ according to their chemical characteris- Computed tomography; tics. Symptoms can vary significantly among individuals, ranging from asymptomatic to severe, Aspiration pneumonia; life-threatening disease. Acute, sometimes fatal, cases can occur, but the disease is usually Bronchoalveolar lavage; indolent. Possible complications include superinfection by nontuberculous mycobacteria, Lung diseases pulmonary fibrosis, respiratory insufficiency, cor pulmonale, and hypercalcemia. The radiolog- ical findings are nonspecific, and the disease presents with variable patterns and distribution. For this reason, lipoid pneumonia may mimic many other diseases. The diagnosis of exogenous lipoid pneumonia is based on a history of exposure to oil, characteristic radiological findings, and the presence of lipid-laden macrophages on sputum or BAL analysis. High-resolution computed tomography (HRCT) is the best imaging modality for the diagnosis of lipoid pneu- monia. The most characteristic CT finding in LP is the presence of negative attenuation values within areas of consolidation.
    [Show full text]
  • Pathogenesis of Experimental Pulmonary Alveolar Proteinosis
    Thorax: first published as 10.1136/thx.25.2.230 on 1 March 1970. Downloaded from Thorax (1970), 25, 230. Pathogenesis of experimental pulmonary alveolar proteinosis B. CORRIN and E. KING Department of Morbid Anatomy, St. Thomas's Hospital Medical School, London, S.E.I, and the Occupational Hygiene Service, Manchester University Rats exposed to various airborne dusts developed a condition identical to pulmonary alveolar proteinosis as seen in man. The experimental condition developed through a stage of endogenous lipid pneumonia, characterized by numerous large foamy macrophages widely distributed through- out the lung. These cells broke down to release a finely granular material which finally condensed to reproduce the appearances of alveolar proteinosis. Electron microscopy indicated that the alveolar material was produced by type II pneumocytes and may therefore represent puImonary surfactant. A study of the dust-handling mechanism showed that in affected animals macrophage mobility was seriously impaired. Recent experiments comparing the effect of similar groups exposed under identical conditions to various dusts on the rat lung have been compli- various quartz modifications including the same purecopyright. cated by a process which as it advances repro- quartz did not contract alveolar proteinosis. Two duces the histological appearances of pulmonary groups of 24 rats each served as controls and alveolar proteinosis (Rosen, Castleman, and remained free of disease. The animals were killed Liebow, 1958). This complication was first en- with coal gas at monthly intervals up to 27 months. Details of the dusts, dust exposure apparatus, dust http://thorax.bmj.com/ countered in rats exposed to an aluminium dust concentrations, and chemical methods are given else- cloud (Corrin, 1962).
    [Show full text]
  • Occupational Asthma Due to Oil Mists
    Thorax: first published as 10.1136/thx.43.3.200 on 1 March 1988. Downloaded from Thorax 1988;43:200-205 Occupational asthma due to oil mists A S ROBERTSON, D C WEIR, P SHERWOOD BURGE From the Occupational Lung Disease Unit, East Birmingham Hospital, Birmingham ABSTRACT Twenty five patients who were exposed to oil mists at their place of work were investigated for possible work related asthma. Serial peak expiratory flow recordings showed 13 to have definite work related asthma, seven equivocal work related asthma, and three asthma unrelated to work; two had normal recordings. Subjects with work related asthma often produced different patterns ofpeak flow response during the working week; patterns also varied between patients. Six of these patients had bronchial tests with oil from their place of work. Three had asthma induced by exposure to unused (clean) soluble oil and one reacted to used but not to clean oil. The challenge tests in the remaining two gave inconclusive results. It is concluded that occupational asthma due to oil mists is common, the peak flow response is heterogeneous, and the provoking agent within the oil may vary from worker to worker. Many workers, particularly in machine shops, are possible cause of lung cancer,'2"3 but this is un- occupationally exposed to oil mists. These may occur likely.' '5'4 Despite the fact that respiratory symptoms in high concentrations and often more than one oil is are more common in workers exposed to oil mists'6 '7copyright. in use.' Industrial oils are in common use as coolants, and are related to the ambient concentration of oil cutting fluids, and lubricants.
    [Show full text]