Diagnosis Of Lipoid Pneumonia Research Articles

Makine Yağı İçimi Sonrası Görülen Bir Lipoid Pnömoni: Nadir Bir Olgu Sunumu

Amaç: Lipoid pnömoni akciğere yağ bazlı sıvı aspirasyonu sonrası ortaya çıkan klinik ve radyolojik bir
 tablodur. Bu vakada rezorbe olmayan pnömoninin bir nedeni olarak kaza sonucu makine yağı içimine
 bağlı gelişen ekzojen lipoid pnömoni olgusu sunulması amaçlanmıştır.
 Olgu: Altmışiki yaşında erkek hasta, 20 gün önce kazara makine yağı içtiğini ifade ederek göğüs hastalıkları
 polikliniğine aldığı tedavi sonrası kontrol muayene amacı ile başvurdu. Pnömoni ön tanısı ile
 ayaktan antibiyotik başlanmış olup kontrollerinde radyolojik düzelme olmadığı öğrenildi. Özgeçmişinde
 benign prostat hiperplazisi ve hipotiroidizm tanıları mevcut idi. Hastanın toraks bilgisayarlı tomografisinde
 sağ akciğer orta lobda hava bronkogramı, yağ dansitesinde odaklar olan ve buzlu camın eşlik
 ettiği lezyon olduğu görüldü. Ayrıca yapılan bronkoalveolar lavaj örneğinde %38 polimorf nüveli lökosit,
 %27 lenfosit, %29 alveolar makrofaj tespit edildi. Lipoid pnömoni tanısı ile metilprednizolon 32 mg/gün
 peroral başlandı. Tedavi sonrası akciğer grafisinde radyolojik olarak iyileşme görülen hasta ayaktan
 takibe alındı.
 Sonuç: Lipoid pnömoni, klinik ve radyolojik olarak diğer pnömoni tipleriyle karışması nedeniyle tanısı
 atlanabilmektedir. Sonuç olarak iyileşmeyen pnömonilerin ayırıcı tanısı yapılırken hasta anamnezi,
 kliniği ve görüntülemeleri dikkatlice değerlendirilmeli ve izlenmelidir

EP1.09-11 Lipoid Pneumonia Resembling Bilateral Lung Cancer: Be Aware of Nasal Decongestants!

To describe a case of bilateral exogenous lipoid pneumonia mimicking lung cancer in a patient affected by obstructive sleep apnea syndrome treated with decongestants mineral oils. A 57 year-old male patient was referred to our surgical department for an incidental finding of a bilateral pulmonary mass during a chest X-ray made for chronic coughing. His past medical history was unremarkable; he was an everyday smoker with a 80pack/years and he was affected by obstructive sleep apnea syndrome. A chest CT and CT/PET scans was subsequently done and revealed the presence of a both pulmonary consolidations of the lower lobes bilaterally with increase in uptake of FDG (Fig. 1A-B): mediastinal lymph node was normal, no other lesions was found. Morphology of the lesions was strongly suspect for non small cells lung cancer, so the patient underwent a CT-guided lung biopsy. A percutaneous CT-guided lung biopsy was done in the right lower lobe. The histological examination was consistent with pulmonary adenocarcinoma with signet-ring cell features (Fig.1C): therefore, the patient was addressed to conventional chemotherapy. At that point, a multidisciplinary discussion was done: a careful revision of the chest CT-scan was carried out and focal areas of fat attenuation within the lung consolidations were observed. According to that finding, a diagnosis of lipoid pneumonia was hypothesized. A more careful questioning about patient’s medical history revealed the use of daily nasal decongestants during the last 4 years due to chronic rhinitis secondary to OSAS: the drug was composed of mineral oils. A further blind revision of the histological tissue samples was requested and confirmed the diagnosis of exogenous lipoid pneumonia. The patient was invited to discontinue the nasal oil decongestant. No other pharmacological treatment was started. Six months later, a chest CT-scan was performed but no significant changing of the pulmonary consolidations were observed (Fig. 1D). Currently, the patient is well and a reduction of chronic coughing was reported. Exogenous lipoid pneumonia is a rare condition that might be misdiagnosed with lung cancer; for this reason it should be considered in the differential diagnosis of pulmonary consolidations, especially when occurring bilaterally. A precise medical history could be resolutive.

LIPOID PNEUMONIA, AN UNEXPECTED DIAGNOSIS IN A HEALTHY MIDDLE-AGED PATIENT

SESSION TITLE: Medical Student/Resident Occupational and Environmental Lung Diseases SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Lipoid pneumonia is a rare pneumonitis most often caused by aspiration of over-the-counter oil regimens such as nasal spray or mineral oil. The disease typically occurs in patients who are elderly or who have disorders that affect swallowing such as achalasia or reflux. CASE PRESENTATION: A 56-year-old woman presented to her regular doctor with complaint of left chest pain with deep breaths without coughing or fever. A Chest x-ray was performed, revealing bibasilar airspace disease in her right middle and left lower lobes. She was prescribed levofloxacin for 14 days. Her next x-ray showed no change to the infiltrates present. A Chest CT scan was obtained and confirmed dense left lower and right middle lobe consolidations without cavitation or malignant appearing pulmonary lesions. She was prescribed a second round of the same antibiotic in addition to prednisone. She was seen again in one month with improved symptoms, but she continued to show infiltrates on imaging. A CBC, ESR/CRP, Histoplasma, Legionella, Mycoplasma, and Blastomyces antibodies had all returned negative. She was then scheduled for CT guided biopsy of the left infiltrate. The sample ultimately showed lipid-laden “foamy” macrophages with some alveolar hyperplasia consistent with lipoid pneumonia. Further questioning revealed that she had been using mineral oil for several years before quitting but never noticed difficulty with swallowing and had no history of reflux, achalasia, or any neuromuscular disease. DISCUSSION: This patient’s history points to an exogenous source for her lipoid infiltration. Clinically, exogenous lipoid pneumonia can present in many ways, including severe shortness of breath with chest pain or asymptomatic. Our patient had both these presentations during her course. The current recommendations are to remove the potential causative agent and provide supportive care. Antibiotics and steroids have not been consistently shown to be effective in treatment. Our patient failed to see improvement with two long antibiotic courses and a steroid burst but symptoms gradually subsided after she had stopped ingesting oil. Lipoid pneumonia can lead to unnecessary administration of antibiotics and steroids as it did in our patient. It is also important to note also that our patient contracted this disease despite having none of the typical risk factors. CONCLUSIONS: This case highlights why it is important to consider this diagnosis of lipoid pneumonia in patients with a history of ingesting oil substances even in the absence of typical risk factors. Reference #1: Kuroyama M et al. Exogenous lipoid pneumonia caused by repeated sesame oil pulling: a report of two cases. BMC Pulm Med. 2015 Oct 30;15:135 Reference #2: Prasad KT et al. An Unusual Cause of Organizing Pneumonia: Hydrocarbon Pneumonitis. J Clin Diagn Res. 2017 Jun;11(6):OD03-OD04 Reference #3: Tavare AN et al. Exogenous Lipoid Pneumonia Mimicking Multifocal Bronchogenic Carcinoma. J Thorac Oncol. 2015 Dec;10(12):1809-10 DISCLOSURES: No relevant relationships by Clifford Hecht, source=Web Response

"Diesel siphoner′s lung": Exogenous lipoid pneumonia following hydrocarbon aspiration

Lipoid pneumonia is an unusual and uncommon form of pneumonia caused by aspiration of fatty substances. Hydrocarbon pneumonitis following aspiration of diesel is a form of exogenous lipoid pneumonia wherein, aspirated diesel reaches the alveoli rapidly without evoking any significant cough, but initiates an intense inflammatory reaction in the pulmonary parenchyma. This is a rarely described clinical scenario, although the practice of diesel siphonage from automobiles is a common practice in developing countries. We herein describe a 40-year-old male patient, in whom the diagnosis of lipoid pneumonia was delayed for a long duration and highlight the importance of taking a detailed occupational exposure history in patients with non-resolving pneumonia to rule out the underlying possibility of this rare clinical entity.

Pulmonary Parenchymal Consolidation on Thoracic CT

Consolidation is defined pathologically as an exudate, or other disease product, that replaces alveolar air and renders the pulmonary parenchyma airless. The chest radiographic appearance of consolidation is usually relatively nonspecific and may be the result of a wide variety of disorders, including infection, neoplasm, hemorrhage, and rare infiltrative diseases. Similarly, the appearance of consolidation on thoracic computed tomography (CT) is rarely specific enough to suggest a single diagnosis. Occasionally, however, the attenuation characteristics of consolidation on thoracic CT may provide a specific etiology for pulmonary parenchymal infiltration; such is the case when low attenuation material, representing fat, is seen in patients with lipoid pneumonia on thoracic CT. Often the diagnosis of lipoid pneumonia is difficult to establish clinically, and abnormalities detected on thoracic CT may first suggest this condition. Once thoracic CT indicates the presence of lipoid pneumonia, directed history often discloses the offending agent. Bronchoscopy with bronchioloalveolar lavage may disclose lipid-laden macrophages within the lung parenchyma in selected patients. Therapy may then be directed at discontinuation of the offending lipid and treatment of any coexistent bacterial superinfection. Patients with acute lipoid pneumonia often improve clinically and radiographically with appropriate therapy, whereas patients with chronic lipoid pneumonia may show relatively little improvement despite appropriate treatment.

Latrogenic lipoid pneumonia in an adult horse

A 20-year-old gelding presented with a history of acute respiratory distress which began immediately after administration of a mineral oil and water mix, via nasogastric intubation, for treatment of suspected gastrointestinal dysfunction. An initial presumptive diagnosis of acute lipoid pneumonia was made; this was further supported by evidence of arterial hypoxaemia and oxygen desaturation on arterial blood gas analysis, ultrasonographic signs of bilateral ventral lung consolidation and a mixed bronchoalveolar-interstitial lung pattern seen on thoracic radiographs. Despite intensive supportive therapy the horse's condition continued to deteriorate and the decision was made for humane euthanasia. Gross necropsy findings supported the clinical diagnosis of lipoid pneumonia.

Lipoid Pneumonia Complicating Megaesophagus Secondary to Chagas Disease

The aim of this study was to evaluate high-resolution computed tomography (HRCT) findings in patients with exogenous lipoid pneumonia after mineral oil aspiration, in association with chagasic megaesophagus. The study included 6 patients aged from 63 to 88 years (mean age, 74.5 y). The inclusion criteria were an abnormal HRCT, a history of aspirating mineral oil, the presence of intrapulmonary lipids in bronchoalveolar lavage, and the presence of megaesophagus with a diagnosis of Chagas disease. Primary HRCT findings included airspace consolidation with air bronchograms (n=4) and a crazy-paving pattern (n=2), predominating bilaterally in the posterior and lower regions of the lungs and associated with esophageal dilatation. The diagnosis of lipoid pneumonia should be considered in chagasic patients with megaesophagus and a history of aspirating mineral oil, presenting with parenchymal consolidations or crazy-paving pattern in HRCT.

Lipoid pneumonia presenting as non resolving community acquired pneumonia: a case report

IntroductionLipoid pneumonia is a rare form of pneumonia caused by inhalation or aspiration of fat containing substances like, petroleum jelly, mineral oils, few laxatives etc. It usually presents as insidious onset chronic respiratory illness simulating interstitial lung diseases. Rarely, it may present as an acute respiratory illness, specially, when exposure to fatty substance is acute and/or massive. Radiologically, it may mimic carcinoma, acute or chronic pneumonia, ARDS, or a localized granuloma. Diagnosis of LP requires demonstration of lipid laden macrophages in sputum, bronchoalveolar lavage fluid or fine needle aspiration cytology/biopsy from lung lesion. Treatment of this illness is poorly defined and constitutes supportive therapy and corticosteroids.Case presentationA 20-year old Indian farmer was referred to us with a diagnosis of non resolving community acquired pneumonia. Respiratory examination revealed signs of consolidation. Chest radiograph revealed findings suggestive of bilateral consolidation. Sputum and blood culture were sterile. He was treated with prolonged course of various antibiotics without any significant response. For evaluation of non resolving pneumonia fibreoptic bronchoscopy was done. Bronchoalveolar lavage fluid and biopsy from lung lesion showed lipid laden macrophages. Hence diagnosis of lipoid pneumonia was made. Patient was treated with course of corticosteroids with good response. Literature on this rare entity is discussed.ConclusionLipoid pneumonia is a rare form of pneumonia which rarely present acutely resembling community acquired pneumonia and requires high degree of suspicion for diagnosis. Its treatment is difficult and poorly defined. However, prolonged corticosteroids may be effective.

A Case of Lipoid Pneumonia Induced by Aspiration of Shark Liver Oil

Lipoid pneumonia is a chronic inflammatory reaction of the lungs that results from the aspiration of vegetable, animal, or mineral oils. The most frequently implicated agent is mineral oil used as a laxative and to reduce dysphagia. Lipoid pneumonia is suggested when there is a history of chronic oral or intranasal use of an oil- or lipid-based product. The characteristic findings of lipid materials in CT or MRI are used in the diagnosis of lipoid pneumonia. The presence of lipid-laden macrophages in the sputum, bronchoalveolar larvage or pulmonary parenchymal biopsy confirms the diagnosis. Sputum study is simple and inexpensive. We report a case of lipoid pneumonia of 75 year old male with cough and sputum, confirmed by sputum study, and review the literature.

Diagnosis of Lipoid Pneumonia by Computed Tomography

Computed tomography (CT) can establish the diagnosis of lipoid pneumonia in lung masses by detecting fat. In this case report, the diagnosis of lipoid pneumonia was first suggested by CT, supported by a long history of mineral oil ingestion, and confirmed by needle aspiration biopsy of the larger of two lung lesions and specific stains. In the future, the detection of fat in lung masses by CT will warrant intermittent follow-up by routine chest x-ray films. Needle aspiration biopsy or surgery would be needed only if a mass showed signs of growth.

Diagnosis of lipoid pneumonia by computed tomography

Computed tomography (CT) can establish the diagnosis of lipoid pneumonia in lung masses by detecting fat. In this case report, the diagnosis of lipoid pneumonia was first suggested by CT, supported by a long history of mineral oil ingestion, and confirmed by needle aspiration biopsy of the larger of two lung lesions and specific stains. In the future, the detection of fat in lung masses by CT will warrant intermittent follow-up by routine chest x-ray films. Needle aspiration biopsy or surgery would be needed only if a mass showed signs of growth. (<i>JAMA</i>1981;245:65-66)

Lipoid Granulomata in Scalene Node

Excerpt To the editor: Varkey and Kutty (1) suggest that the finding of mineral oil in a scalene node biopsy may aid in the diagnosis of lipoid pneumonia. Although aspirated mineral oil may well re...

Diagnosis of lipoid pneumonia

1. 1. Lipoid pneumonia occurs not only in chronically debilitated adults or in physically handicapped children, but also has been observed in apparently healthy individuals. Mineral oil is the most common cause of this condition since it is widely used as a mild laxative as well as a vehicle for oily nose drops, thorat lubricants or various oil-containing medications. 2. 2. The differential diagnosis of lipoid pneumonia frequently causes considerable difficulty since this condition may be confused with other pulmonary diseases such as low grade infections, tuberculosis, fungus disease, sarcoidosis or benign and malignant neoplasms. 3. 3. The recognition of lipoid pneumonia is of particular importance in those patients in whom a diagnosis of bronchogenic carcinoma is entertained because needless surgical intervention may be avoided. 4. 4. The clinical findings are not characteristic, and include productive cough, dyspnea, febrile exacerbations and chest findings associated with pulmonary consolidation. In many instances the patients are asymptomatic. 5. 5. The diagnosis of lipoid pneumonia can be established clinically with a considerable degree of accuracy by correlating the roentgenographic findings with cytologic studies of the sputum as well as of material aspirated transthoracically from the lung. 6. 6. The positive sputum contains lipophages and abundant amounts of free sudanophilic material, while the material aspirated from the lung is considered positive when the characteristic lipophages, single or arranged in clusters and frequently transformed into giant cells, are found. 7. 7. The roentgenographic features indicative of lipoid pneumonia are discussed. 8. 8. The mechanism of the progressive nature of the disease after discontinuance of the inciting liquid petrolatum is suggested as being due to reaspiration of disintegrated lipophages. 9. 9. Early clinical recognition of lipoid pneumonia may prevent extensive spread of the pulmonary involvement by discontinuing the intake of mineral oil or other oil-containing medications.

Diagnosis of Lipoid Pneumonia by Aspiration Biopsy

Within the past fifteen years lipoid pneumonia has been repeatedly reported in the literature. In almost every reported instance the diagnosis was a pathologic one made on autopsy material. In an occasional case the diagnosis was suggested by the history and the clinical findings, and the subsequent improvement followed discontinuance of the use of various oral and nasal oils.1In rare instances oil droplets have been visualized bronchoscopically and the diagnosis made in that way. It occurred to us that biopsy of material aspirated from the lungs, a procedure now in use in the study of obscure pulmonary and mediastinal lesions, would be of value, and we were successful in corroborating the suggested roentgenographic diagnosis of lipoid pneumonia in 5 of 10 cases examined in this way. As far as we can determine, this is the first report of lipoid pneumonia demonstrated by aspiration biopsy. REPORT OF CASES Case

DIAGNOSIS OF LIPOID PNEUMONIA BY ASPIRATION BIOPSY

Within the past fifteen years lipoid pneumonia has been repeatedly reported in the literature. In almost every reported instance the diagnosis was a pathologic one made on autopsy material. In an occasional case the diagnosis was suggested by the history and the clinical findings, and the subsequent improvement followed discontinuance of the use of various oral and nasal oils.1In rare instances oil droplets have been visualized bronchoscopically and the diagnosis made in that way. It occurred to us that biopsy of material aspirated from the lungs, a procedure now in use in the study of obscure pulmonary and mediastinal lesions, would be of value, and we were successful in corroborating the suggested roentgenographic diagnosis of lipoid pneumonia in 5 of 10 cases examined in this way. As far as we can determine, this is the first report of lipoid pneumonia demonstrated by aspiration biopsy. REPORT OF CASES Case