Roentgenographic Changes Following the Introduction of Mineral Oil in the Lung

Abstract

MINERAL oil has been used for many years in the treatment of certain of the diseases of the respiratory tract but only within the past ten years has attention been directed to the possibility of pathologic sequelæ to oil within the lungs. The earlier reports of lung injuries were those in which accidental aspiration of oils had occurred in young and debilitated infants. Cases of this nature have been reported by Goodwin (14), Grayzel and Du Mortier (15), Laughlen (22), Pinkerton (27), Rabinovitch and Lederer (30) and by Pollak and Potter (29). Most of their cases had been diagnosed clinically as bronchopneumonia, the correct diagnosis having been made at autopsy. The fundamental pathologic process was found to have been the presence of numerous large mononuclear phagocytes containing oil droplets and the marked proliferation of the connective tissue in the alveolar walls. The type and the degree of the reaction varied, depending on the amount and the duration of the oil in the lung prior to autopsy. Up to the present time only five instances of fatal lung injury in adults, due to oil, have been reported in the literature. One patient (33) had aspirated butter fat because of cardiospasm; in another (19) the source of the oil was not determined; Laughlen's patient (22), who had a laryngeal paralysis, was given naso-pharyngeal instillations of mineral oil. In the remaining two cases (4, 10), the condition followed prolonged use of large amounts of mineral oil in the nose. In all of these cases the secondary fibrosis was the most significant part of the pathologic findings. Pinkerton (28), in a series of experiments on dogs and rabbits, definitely proved that the intratracheal instillation of mineral oil produced marked pulmonary changes, consisting of fibrosis of the alveolar walls together with the presence of large numbers of greatly swollen phagocytes, each of which contained numerous small droplets of oil. Pinkerton found that the vegetable oils produced but little reaction in the lung although in some of his animals the oil had been in the lung for several months before autopsy was done. Iodized vegetable oils occasionally caused minute abscesses, especially in areas in which there had been bronchial obstruction, but in most of his animals produced no changes. In the x-ray laboratory at St. Vincent's Hospital we have observed three cases in which there were noted pulmonary changes following prolonged or intensive use of mineral oil in the respiratory tract. In all of these cases oil droplets were found in the sputum. In one of the cases, which went to autopsy, large amounts of oil were found in the lung, the oil being identified as mineral oil by chemical tests. This patient had had no oil administered for a period of six years and eight months prior to the autopsy. From the study of these cases we believe that a rather characteristic roentgenographic picture is produced when an excessive amount of mineral oil is placed in the lung.