LIPOID pneumonia which follows the entrance of oily substances into the lungs is now recognized as a disease entity. The present paper is based on an analysis of 27 cases observed at the Children's Hospital. Twelve of these were found in a series of 137 consecutive autopsies. Other reports give the statistical incidence of this not uncommon condition as follows: Pinkerton (1), six cases in 290 autopsies; Laughlen (2), one case in 300 autopsies; Ikeda (3), seven in 101 autopsies. Goodwin (4) found 25 cases in a period of ten years at the Harriet Lane Home. Laughlen (1925) is generally acknowledged as the first to report and describe the effects of aspiration of oily substances into the lungs. He reported three cases in children following the naso-pharyngeal installation of liquid petrolatum. On pathologic examination, the alveoli were found to contain large quantities of oil, some of which lay free in the alveoli although the greater portion was located within large mononuclear cells. Cuboidal epithelium replaced the usual epithelial lining of the alveoli, similar to the change often found in atelectasis. Later Thomas and Jewett (5) recorded a case of pneumonia following the aspiration of a large quantity of cream. Pinkerton (1) described six cases of lipoid aspiration causing inflammation of the lung. The cases varied in the type of oil aspirated, likewise in the length of time the oily substances had been in the lungs. He was able, because of the latter, to recognize three stages of the disease. The first corresponds to Laughlen's (2) findings; the second was a stage of interstitial fibrosis; the third, practically an end-result, showed a firm nodular fibrosis of the lungs. He noted also, that the mild vegetable oils, such as poppy-seed, olive, and sesame oil, caused the. least reaction, while cod-liver oil, lard, and other animal fats caused a sudden and violent reaction in the lungs with hemorrhage and necrosis. When liquid petrolatum was aspirated, proliferative pneumonia followed. He confirmed Laughlen's findings of the frequent association in the lung of infection with lipoid pneumonia. The roentgenograms of Pinkerton's (1) cases showed nothing which could be called characteristic of the condition. Goodwin (4), Ikeda (3), and Pierson (6) described in more detail the roentgenographic findings. The latter in his conclusion stated that the presence of fatty material in the lungs produces a very interesting roentgen picture dependent upon the phase of the disease at the time of examination. He could establish, however, no pathognomonic signs and hoped that his study might stimulate roentgenologists to make further observations which might aid in the roentgen diagnosis. This series of 27 cases of lipoid pneumonia in the Children's Hospital was studied especially from the standpoint of roentgen diagnosis. Of the 27 patients, 22 died, and 20 of that number were autopsied.
Read full abstract