Lipid pneumonia

Aspiration, Bronchial Obstruction, Bronchiectasis, and Related Disorders

The conducting airways play a pivotal role in the spectrum of pulmonary pathology, not only as conduits for injurious agents to enter the lung, but also as an anatomic compartment that is affected by a diverse array of primary or secondary bronchocentric diseases. This chapter discusses aspiration and bronchial obstruction in detail, with emphasis on the aspiration of toxic, infective, or particulate matter. Lung abscess, a frequent complication of obstruction or aspiration, is also reviewed. Both aspiration and lung abscess are reconsidered within the context of pulmonary infectious disease mainly in Chapter 8 on bacterial infections, and to some extent in the chapters on mycobacterial (Chapter 9), fungal (Chapter 10), and parasitic diseases (Chapter 14).

Exogenous lipoid pneumonia caused by facial application of petrolatum

Exogenous lipoid pneumonia is a well-described entity in the literature. To our knowledge, this is the first reported case that occurred secondary to external application of petrolatum to the face for erythrodermic psoriasis.

Radiological and Clinical Findings in Acute and Chronic Exogenous Lipoid Pneumonia

PURPOSE

To describe the radiologic and clinical findings in a group of patients with exogenous lipoid pneumonia focusing on features that differentiate the acute and chronic presentations.

MATERIALS AND METHODS

We retrospectively identified 15 patients from a single institution with exogenous lipoid pneumonia 1992-2001. Inclusion criteria were: imaging with chest CT and either CT features diagnostic of lipoid pneumonia or intrapulmonary lipids on pathologic examination. Each chart was reviewed for the clinical presentation, history of ingestion/exposure, predisposing factors, treatment and response to therapy. Initial (n = 13) and follow-up (n = 11) chest radiographs were reviewed for the patterns and distribution of lung parenchymal abnormalities and pleural effusion. Initial (n = 15) and follow-up (n = 7) CT scans were reviewed for lung parenchymal abnormalities (consolidation, ground glass opacities, linear/nodular opacities, masses, and crazy paving), presence or absence of fat attenuation, and pleural effusion. The groups were compared using the Fischer exact test.

RESULTS

Nine patients had acute lipoid pneumonia, 7 males and 2 females with a mean age of 45 (range 4.5-81) years. Six patients had chronic lipoid pneumonia, 4 men and 2 women with a mean age of 63 (range 37-83) years. 78% (7/9) of patients with acute and all of the patients with chronic presentations had a known ingestion and/or a predisposing condition associated with lipoid pneumonia. On chest radiographs, consolidation and lower lobe involvement were present in the majority of patients with acute and none of the patients with chronic presentations. On CT, consolidation and fat attenuation were present in the majority of patients with each presentation. However, masses were present in 67% (4/6) of patients with chronic and none of the patients with acute presentation (P < 0.05). 86% (6/7) of patients with acute presentation had improvement on follow-up chest radiograph in contrast to none of the patients with chronic presentation (P < 0.05). 75% (3/4) of patients with acute lipoid pneumonia had improvement on follow-up CT in contrast with 67% (2/3) of patients with chronic lipoid pneumonia who had progression on follow-up CT.

CONCLUSIONS

The imaging features of acute and chronic lipoid pneumonia overlap with consolidation and lower lobe involvement present in both groups. However, only the patients with acute lipoid pneumonia had pleural effusions and improvement on follow-up. Only the patients with chronic lipoid pneumonia had pulmonary masses.

Self-injection with olive oil. A cause of lipoid pneumonia

A 48-year-old man with unipolar depression and a psychosexual problem concerning his body image was injecting his scrotum repeatedly with olive oil to increase the size of his genitals. He developed respiratory failure following accidental intravenous injection of olive oil and was found to have lipogranulomatous lesions in the lung and the scrotum.