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Murphy RJ, Tessier S, Longo S, Alia CS, Ido F. Extrinsic lipoid pneumonia due to chronic polyethylene glycol consumption: A case report. Respir Investig 2023; 61:768-772. [PMID: 37716285 DOI: 10.1016/j.resinv.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 09/18/2023]
Abstract
Extrinsic lipoid pneumonia (ELP) results from the aspiration of lipid-containing substances. Tissue or cell histopathology after Oil-Red-O staining can confirm the diagnosis, which requires proper tissue handling and preparation during bronchoscopy. Here, we report a case of ELP in a quadriplegic patient with a long history of dysphagia and polyethylene glycol consumption. Computed tomography (CT) of the chest revealed multiple, progressively enlarging, fat-attenuated, nodular pulmonary lesions. Bronchoscopy with bronchoalveolar lavage (BAL) and a transbronchial forceps biopsy confirmed the diagnosis of lipoid pneumonia. We discuss the clinical, radiological, and pathological features of ELP and highlight the preparatory steps required for obtaining a successful diagnosis.
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Affiliation(s)
- Robert J Murphy
- Lewis Katz School of Medicine, Temple University, 3500 N. Broad Street, Suite 124, Philadelphia, PA 19140, USA
| | - Steven Tessier
- Lewis Katz School of Medicine, Temple University, 3500 N. Broad Street, Suite 124, Philadelphia, PA 19140, USA
| | - Santo Longo
- Department of Pathology, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA
| | - Christopher S Alia
- Department of Pulmonology and Critical Care, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA
| | - Firas Ido
- Department of Pulmonology and Critical Care, St. Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA.
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2
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Wang H, Lu S, Li H, Wang Y. Mycobacterium infection secondary to exogenous lipoid pneumonia caused by nasal drops: a case report and literature review. BMC Pulm Med 2023; 23:47. [PMID: 36721116 PMCID: PMC9887914 DOI: 10.1186/s12890-022-02265-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/24/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Exogenous lipoid pneumonia (ELP) is a rare disease and its diagnosis is often mistaken or delayed. Secondary infection with rapidly growing non-tuberculous mycobacteria is a rare complication of lipoid pneumonia. CASE PRESENTATION A 38-year-old man presented with fever, cough, sputum, chest tightness, and shortness of breath. He had a 2-year history of allergic rhinitis and used liquid paraffin-containing menthol nasal drops daily. A chest CT scan showed multiple patchy ground glass opacities with blurred borders in both lungs, which were located in the inner pulmonary field and distributed along the bronchi. His ambient air PO2 was 63 mmHg. The patient was diagnosed with ELP by CT-guided lung biopsy. The nasal drops were discontinued, and systemic glucocorticoids were administered. During treatment, the pulmonary lesions deteriorated, and bronchoalveolar lavage was performed during bronchoscopy. Additionally, Mycobacterium abscessus was detected in the lavage fluid. Upon detection of a secondary M. abscessus infection, glucocorticoids were gradually discontinued, and anti-M. abscessus treatment was implemented. The patient's symptoms rapidly ameliorated. After 11 months of anti-M. abscessus treatment, a repeat CT scan showed clear regression of the lung lesions. CONCLUSION Routine microbiological examination of samples, including sputum or alveolar lavage fluid, is necessary for patients with diagnosed or suspected ELP.
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Affiliation(s)
- Huihong Wang
- grid.13402.340000 0004 1759 700XDepartment of Respiratory Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 China ,grid.469636.8Department of Respiratory Diseases, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000 Zhejiang Province China
| | - Shan Lu
- grid.13402.340000 0004 1759 700XDepartment of Respiratory Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 China
| | - Hequan Li
- grid.13402.340000 0004 1759 700XDepartment of Respiratory Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 China
| | - Yuehong Wang
- grid.13402.340000 0004 1759 700XDepartment of Respiratory Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 China
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牛飼 純, 桑波田 聡, 窪田 唯, 佐田 千, 手塚 綾, 岩谷 徳, 竹中 俊, 大石 充. [An elderly male patient with dementia who showed repeated episodes of pneumonia due to chronic oral intake of kerosene]. Nihon Ronen Igakkai Zasshi 2023; 60:448-450. [PMID: 38171763 DOI: 10.3143/geriatrics.60.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
| | | | | | | | | | | | | | - 充 大石
- 鹿児島大学大学院医歯学総合研究科心臓血管・高血圧内科学
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4
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Colbenson GA, Dempsey TM, Cecchini MJ, Aubry MC, Moua T, Ryu JH. A Bodybuilder with Dyspnea and Hypercalcemia. Am J Med 2021; 134:e363-e365. [PMID: 33316251 DOI: 10.1016/j.amjmed.2020.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Matthew J Cecchini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | | | - Teng Moua
- Division of Pulmonary and Critical Care Medicine
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine
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Guarnera A, Podda P, Santini E, Paolantonio P, Laghi A. Differential diagnoses of COVID-19 pneumonia: the current challenge for the radiologist-a pictorial essay. Insights Imaging 2021; 12:34. [PMID: 33704615 PMCID: PMC7948690 DOI: 10.1186/s13244-021-00967-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND COVID-19 pneumonia represents the most severe pandemic of the twenty-first century and has crucial clinical, social and economical implications. The scientific community has focused attention and resources on clinical and radiological features of COVID-19 pneumonia. Few papers analysing the vast spectrum of differential diagnoses have been published. MAIN BODY Complexity of differential diagnosis lays in the evidence of similar radiological findings as ground-glass opacities, crazy paving pattern and consolidations in COVID-19 pneumonia and a multitude of other lung diseases. Differential diagnosis is and will be extremely important during and after the pandemic peak, when there are fewer COVID-19 pneumonia cases. The aim of our pictorial essay is to schematically present COVID-19 pneumonia most frequent differential diagnoses to help the radiologist face the current COVID-19 pneumonia challenge. CONCLUSIONS Clinical data, laboratory tests and imaging are pillars of a trident, which allows to reach a correct diagnosis in order to grant an excellent allocation of human and economical resources. The radiologist has a pivotal role in the early diagnosis of COVID-19 pneumonia because he may raise suspicion of the pathology and help to avoid COVID-19 virus spread.
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Affiliation(s)
- Alessia Guarnera
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
| | - Pierfrancesco Podda
- Department of Radiology, San Giovanni Addolorata Hospital, Via Dell'Amba Aradam 9, 00184, Rome, Italy
| | - Elena Santini
- Department of Radiology, San Giovanni Addolorata Hospital, Via Dell'Amba Aradam 9, 00184, Rome, Italy
| | - Pasquale Paolantonio
- Department of Radiology, San Giovanni Addolorata Hospital, Via Dell'Amba Aradam 9, 00184, Rome, Italy
| | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
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Han C, Liu L, Du S, Mei J, Huang L, Chen M, Lei Y, Qian J, Luo J, Zhang M. Investigation of rare chronic lipoid pneumonia associated with occupational exposure to paraffin aerosol. J Occup Health 2016; 58:482-488. [PMID: 27488044 PMCID: PMC5356983 DOI: 10.1539/joh.16-0096-cs] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objectives: Occupational exposure to paraffin is an infrequent cause of lipoid pneumonia (LP) and related data are scare. We investigated the possible relationship between three rare cases of chronic LP and occupational exposure to paraffin aerosol in an iron foundry. Methods: The three cases of LP and their workplaces were investigated using data from field investigations, air monitoring, pulmonary radiological examinations, cell staining, and lung biopsies. Results: The patients had long-term occupational exposure to paraffin. X-ray diffraction testing revealed that the raw material from the workshop was paraffin crystal. The air concentrations of paraffin aerosol in workplaces were significantly higher than outdoor background levels. Small diffuse and miliary shadows with unclear edges were observed throughout the whole lungs via radiography. Computed tomography revealed diffuse punctate nodules and a high density of stripe-like shadows in both lungs (ground-glass opacity in a lower lobe, and a mass-like lesion and high translucent area near the bottom of the lung). Lipid-laden macrophages were found in the sputum and bronchial lavage. A broadened alveolar septum and local focal fibrosis were also discovered via lung biopsy. The inflammatory reaction in the lung tissues appeared to resolve over time. Conclusions: These three rare cases of chronic LP in workers during molding and repair processes were associated with occupational paraffin aerosol exposure. Therefore, primary prevention is essential for molding or repairing workers in the iron foundry, and a differential diagnosis of occupational chronic LP (vs. pneumoconiosis) should be considered when treating these workers.
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Bouti K, Rhorfi I, Mzouri M, Abid A, Alaoui Tahiri K. Exogenous lipoid pneumonia caused by Nigella sativa oil – A case report. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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8
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Pielaszkiewicz-Wydra M, Homola-Piekarska B, Szcześniak E, Ciołek-Zdun M, Fall A. Exogenous lipoid pneumonia - a case report of a fire-eater. Pol J Radiol 2012; 77:60-4. [PMID: 23269939 PMCID: PMC3529714 DOI: 10.12659/pjr.883631] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 10/09/2012] [Indexed: 01/15/2023] Open
Abstract
Background: Exogenous lipoid pneumonia is an uncommon condition caused by inhalation or aspiration of a fatty substance. It usually presents as chronic respiratory illness mimicking interstitial lung diseases. Acute exogenous lipoid pneumonia is uncommon and typically is caused by an episode of aspiration of a large quantity of a petroleum-based product. Radiological findings vary and may imitate many other diseases. Case Report: We present a rare case of acute exogenous lipoid pneumonia in a fire-eater who aspirated liquid paraffin during his flame-blowing show (fire-eater’s lung). He was admitted to the hospital with productive cough, fever, hemoptysis, chest pain and dyspnea. Diagnosis was made on the basis of history of exposure to fatty substance, characteristic findings in CT examination and presence of lipid-laden macrophages in bronchoalveolar lavage fluid. Conclusions: Acute exogenous lipoid pneumonia is a very rare disease that typically occurs in fire-eaters and is called a fire-eater’s lung. The diagnosis is made on the basis of typical history and radiological, as well as histopathological findings.
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9
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Exogenous lipoid pneumonia. Clinical and radiological manifestations. Respir Med 2011; 105:659-66. [DOI: 10.1016/j.rmed.2010.12.001] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 11/28/2010] [Accepted: 12/01/2010] [Indexed: 11/23/2022]
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11
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Lipoid pneumonia in 53 patients after aspiration of mineral oil: comparison of high-resolution computed tomography findings in adults and children. J Comput Assist Tomogr 2010; 34:9-12. [PMID: 20118714 DOI: 10.1097/rct.0b013e3181a9ec9f] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the high-resolution computed tomography (HRCT) findings in 53 patients with exogenous lipoid pneumonia and to compare the imaging features of adults and children. MATERIALS AND METHODS The study included 35 children and 18 adults. Statistical comparisons of findings in the 2 age groups were performed using either Pearson chi2 or Fisher exact test, as appropriate, at 5% significance level. RESULTS The main HRCT findings included air-space consolidation, ground glass attenuation, air-space nodules, and crazy-paving pattern. Abnormalities predominated in the posterior regions of the right lung. The right lower lobe was most likely to show severe involvement. CONCLUSIONS The presence of air-space consolidation, the involvement of upper right lobe, and the central and posterior distribution of the lesions were more common in children, whereas the crazy-paving pattern and random localization were significantly more frequent in adults. The other findings were not different between the 2 groups.
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12
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Choi JH, Kim MK, Park JG, Park YK, Choi KH, Lee KM, An JY. A Case of Lipoid Pneumonia Associated with Silicon Oil Injection into Breast. Tuberc Respir Dis (Seoul) 2010. [DOI: 10.4046/trd.2010.69.4.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jae Hyeon Choi
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University School of Medicine, Cheongju, Korea
| | - Mi Kyoung Kim
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University School of Medicine, Cheongju, Korea
| | - Jae Geun Park
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University School of Medicine, Cheongju, Korea
| | - Yong Kun Park
- Department of Internal Medicine, The Cheongju St. Mary's Hospital, Cheongju, Korea
| | - Kang Hyeon Choi
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University School of Medicine, Cheongju, Korea
- Chungcheong Respiratory Institute, Cheongju, Korea
| | - Ki Man Lee
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University School of Medicine, Cheongju, Korea
- Chungcheong Respiratory Institute, Cheongju, Korea
| | - Jin Young An
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University School of Medicine, Cheongju, Korea
- Chungcheong Respiratory Institute, Cheongju, Korea
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13
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Mathai SK, Rubinowitz AN, Homer RJ, Detterbeck F, Herzog EL. Of Lungs, Lipids, and Lollipops. Chest 2009; 136:1420-1423. [DOI: 10.1378/chest.08-2133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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14
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Chawla M, Boroumand N, Alexandrou C, Stover D. Dyspnea on exertion and ground-glass infiltrates in an ex-smoker. Chest 2008; 134:1320-1324. [PMID: 19059963 DOI: 10.1378/chest.07-2119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Mohit Chawla
- Department of Medicine, Section of Pulmonary Medicine, New York, NY.
| | - Nahal Boroumand
- Department of Pathology, Section of Thoracic Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Diane Stover
- Department of Medicine, Section of Pulmonary Medicine, New York, NY
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15
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Positron emission tomography-positive squalene-induced lipoid pneumonia confirmed by gas chromatography-mass spectrometry of bronchoalveolar lavage fluid. Am J Med Sci 2008; 335:310-4. [PMID: 18414072 DOI: 10.1097/maj.0b013e31811ec1a0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Squalene is a type of oil obtained from shark liver. We describe a 76-year-old man diagnosed with chronic exogenous lipoid pneumonia due to squalene. A chest CT scan revealed pulmonary consolidation with ground-glass opacities in the right upper lobe. Positron emission tomography (PET) revealed significant uptake of 2-deoxy-2-F-fluoro-d-glucose (FDG) and 3'-deoxy-3'-F-fluorothymidine (FLT). Bronchoalveolar lavage (BAL) fluid contained many lipid-laden macrophages, and a transbronchial lung biopsy specimen showed clusters of foamy macrophages in alveolar spaces and granulomatous lesions. In addition, the presence of squalene in the BAL fluid was confirmed by gas chromatography-mass spectrometry, leading to a diagnosis of squalene-induced lipoid pneumonia. To the best of our knowledge, this is the first report of squalene-induced lipoid pneumonia in which squalene itself was successfully detected. This case also suggests the possibility that lipoid pneumonia shows significant uptake in FDG-PET and FLT-PET.
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Zanetti G, Marchiori E, Gasparetto TD, Escuissato DL, Soares Souza A. Lipoid pneumonia in children following aspiration of mineral oil used in the treatment of constipation: high-resolution CT findings in 17 patients. Pediatr Radiol 2007; 37:1135-9. [PMID: 17876572 DOI: 10.1007/s00247-007-0603-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2007] [Revised: 07/10/2007] [Accepted: 07/19/2007] [Indexed: 12/22/2022]
Abstract
BACKGROUND Exogenous lipoid pneumonia is a rare disorder caused by aspiration of mineral, vegetable and animal oils. High-resolution CT findings of lipoid pneumonia in children taking mineral oil for constipation have been rarely reported. OBJECTIVE To evaluate the high-resolution CT findings in 17 children with exogenous lipoid pneumonia following aspiration of mineral oil. MATERIALS AND METHODS The study included nine boys and eight girls, with ages ranging from 2 months to 9 years. All patients underwent high-resolution CT and the images were reviewed by two radiologists who reached decisions by consensus. The inclusion criteria were an abnormal radiograph, history of taking mineral oil and the presence of intrapulmonary lipids proved by bronchoalveolar lavage or open lung biopsy. RESULTS The most common symptoms were cough (n = 13), mild fever (n = 11), and progressive dyspnea (n = 9). The main CT findings were air-space consolidations (100%), usually with areas of fatty attenuation (70.6%), areas of ground-glass attenuation (52.9%), and a crazy-paving pattern (17.6%), predominating bilaterally in the posterior and lower regions of the lungs. CONCLUSION The high-resolution CT features in children with exogenous lipoid pneumonia are air-space consolidations and ground-glass attenuation, occasionally with a crazy-paving pattern, distributed bilaterally in the posterior and lower zones of the lungs.
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Affiliation(s)
- Gláucia Zanetti
- Department of Radiology, University of Rio de Janeiro, Rio de Janeiro, Brazil
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Simmons A, Rouf E, Whittle J. Not your typical pneumonia: a case of exogenous lipoid pneumonia. J Gen Intern Med 2007; 22:1613-6. [PMID: 17846847 PMCID: PMC2219803 DOI: 10.1007/s11606-007-0280-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 04/16/2007] [Accepted: 06/21/2007] [Indexed: 11/24/2022]
Abstract
The constellation of chronic cough, dyspnea, and hemoptysis can include a broad range of differential diagnoses. Although uncommon, exogenous lipoid pneumonia (ELP) should be considered when patients present with this symptom complex. We report a case of a 72-year-old female who presented with hemoptysis, cough, and dyspnea. The admission computed tomography scan of the chest revealed progressive interstitial infiltrates. Bronchoscopy revealed diffuse erythema without bleeding. Culture and cytology of lavage fluid were negative. Open-lung biopsy revealed numerous lipid-laden macrophages and multinucleated foreign-body giant cells. On further questioning, the patient admitted to the daily use of mineral oil for constipation. The diagnosis of ELP was made. The literature review revealed that many cases typically present with chronic cough with or without dyspnea. Our case illustrates an unusual presenting symptom of hemoptysis and the need to identify patients who can be at risk of developing this rare condition.
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Affiliation(s)
- Ashley Simmons
- Division of General and Geriatric Medicine, University of Kansas Medical Center, Mail stop 1020, Wescoe 5026, 3901 Rainbow Boulevard, Kansas, KS 66160, USA.
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Marchiori E, Zanetti G, Escuissato DL, Souza Jr. AS, Araújo Neto C, Nobre LF, Irion KL, Rodrigues R, Mançano AD, Capone D, Fialho SM, Souza CA. Pneumonia lipoídica em adultos: aspectos na tomografia computadorizada de alta resolução. Radiol Bras 2007. [DOI: 10.1590/s0100-39842007000500007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Apresentar os aspectos na tomografia computadorizada de alta resolução do tórax da pneumonia lipoídica exógena por aspiração de óleo mineral, em pacientes adultos MATERIAIS E MÉTODOS: Foram estudados oito pacientes adultos - quatro mulheres e quatro homens - com média de idade de 69,4 anos, todos usuários de óleo mineral para tratamento de constipação intestinal. Os exames foram avaliados por dois radiologistas, de forma independente RESULTADOS: Os achados tomográficos mais comuns foram as consolidações com áreas de densidade de gordura de permeio, e o padrão de pavimentação em mosaico. As lesões foram bilaterais em seis pacientes, e unilaterais em dois CONCLUSÃO: O encontro de consolidações pulmonares com áreas de densidade de gordura de permeio, associado à história clínica do uso de óleo mineral, é diagnóstico de pneumonia lipoídica exógena.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Domenico Capone
- Universidade Federal do Rio de Janeiro, Brasil; Universidade Estadual do Rio de Janeiro
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Raya AI, Fernández-de Marco M, Núñez A, Afonso JC, Cortade LE, Carrasco L. Endogenous Lipid Pneumonia in a Dog. J Comp Pathol 2006; 135:153-155. [PMID: 16997006 DOI: 10.1016/j.jcpa.2006.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Accepted: 06/10/2006] [Indexed: 10/24/2022]
Abstract
Endogenous lipid pneumonia has previously been diagnosed in dogs only once. This report describes a case in a dog with a persistent cough, in which the histological diagnosis was based on the presence of numerous foamy macrophages that filled the alveoli and contained small sudanophilic vacuoles. The appearance of endogenous lipid pneumonia in this animal was accompanied by Dirofilaria immitis infection and chronic bronchitis.
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Affiliation(s)
- A I Raya
- Departamento de Anatomía y Anatomía Patológica Comparadas, Edificio Sanidad Animal, Campus Universitario Rabanales, Universidad de Córdoba, 14014 Córdoba
| | - M Fernández-de Marco
- Departamento de Anatomía y Anatomía Patológica Comparadas, Edificio Sanidad Animal, Campus Universitario Rabanales, Universidad de Córdoba, 14014 Córdoba
| | - A Núñez
- Departamento de Anatomía y Anatomía Patológica Comparadas, Edificio Sanidad Animal, Campus Universitario Rabanales, Universidad de Córdoba, 14014 Córdoba
| | - J C Afonso
- Clínica Veterinaria La Fuensanta. Avda de la Fuensanta 35, 14010 Córdoba, Spain
| | - L E Cortade
- Clínica Veterinaria La Fuensanta. Avda de la Fuensanta 35, 14010 Córdoba, Spain
| | - L Carrasco
- Departamento de Anatomía y Anatomía Patológica Comparadas, Edificio Sanidad Animal, Campus Universitario Rabanales, Universidad de Córdoba, 14014 Córdoba.
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20
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Webb WR. Thin-section CT of the secondary pulmonary lobule: anatomy and the image--the 2004 Fleischner lecture. Radiology 2006; 239:322-38. [PMID: 16543587 DOI: 10.1148/radiol.2392041968] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The secondary pulmonary lobule is a fundamental unit of lung structure, and it reproduces the lung in miniature. Airways, pulmonary arteries, veins, lymphatics, and the lung interstitium are all represented at the level of the secondary lobule. Several of these components of the secondary lobule are normally visible on thin-section computed tomographic (CT) scans of the lung. The recognition of lung abnormalities relative to the structures of the secondary lobule is fundamental to the interpretation of thin-section CT scans. Pathologic alterations in secondary lobular anatomy visible on thin-section CT scans include interlobular septal thickening and diseases with peripheral lobular distribution, centrilobular abnormalities, and panlobular abnormalities. The differential diagnosis of lobular abnormalities is based on comparisons between lobular anatomy and lung pathology.
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Affiliation(s)
- W Richard Webb
- Department of Radiology, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, USA
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21
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Lee KH, Kim WS, Cheon JE, Seo JB, Kim IO, Yeon KM. Squalene aspiration pneumonia in children: radiographic and CT findings as the first clue to diagnosis. Pediatr Radiol 2005; 35:619-23. [PMID: 15806404 DOI: 10.1007/s00247-005-1439-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2004] [Revised: 12/19/2004] [Accepted: 12/20/2004] [Indexed: 01/21/2023]
Abstract
BACKGROUND The diagnosis of squalene aspiration pneumonia in children is often difficult because of minimal non-specific symptoms. OBJECTIVE To investigate the radiological findings of squalene aspiration pneumonia in children. MATERIALS AND METHODS We reviewed the chest radiographs (n = 8) and CT scans (n = 7), including high-resolution CT (n = 3), of eight patients (four boys, four girls; age 3 months to 6 years) with squalene aspiration pneumonia. All patients presented minimal symptoms. RESULTS Chest radiographs showed right-sided predominantly parahilar infiltrations. The extent and the opacity of the lesions decreased slowly during the follow-up period (mean 5.4 months) after halting the exposure. On CT, affected areas appeared as dense consolidations surrounded by ground-glass opacities showing a crazy-paving pattern in a geographic lobular distribution in all patients. The lesions were predominantly in the right lung and dependent areas in all patients and extensively involved all pulmonary lobes in five patients. CONCLUSIONS These radiological findings, although non-specific, can lead to an appropriate diagnosis, particularly when patients present few symptoms.
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Affiliation(s)
- Kyoung Ho Lee
- Department of Radiology, Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea
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Brown CD, Hewan-Lowe K, Kseibi SA, Huang YY. Exogenous Lipoid Pneumonia Secondary to an Occupational Exposure in a Furntiture Factory. Chest 2004. [DOI: 10.1378/chest.126.4_meetingabstracts.997s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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23
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Affiliation(s)
- David Adkins
- Division of Pulmonary and Critical Care Medicine, University of Kentucky, Lexington, KY 40536-0298, USA
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Farias J, Martins EML, Pozes AS, Fialho SM, Marchiori E. Pneumonia lipídica - aspectos na tomografia computadorizada: relato de caso. Radiol Bras 2004. [DOI: 10.1590/s0100-39842004000100012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os autores relatam um caso de pneumonia lipídica em um paciente de 80 anos de idade, que iniciou o quadro com dispnéia em repouso. Havia história de constipação crônica, com uso freqüente de laxativos oleosos. O paciente apresentava diminuição do nível de consciência e os familiares relatavam tosse e engasgos freqüentes, durante o uso do medicamento. As radiografias de tórax demonstravam consolidação localizada no segmento posterior do lobo superior do pulmão direito, além de opacidades mal definidas nos lobos inferiores e que não se modificavam em exames sucessivos. A tomografia computadorizada de alta resolução mostrou consolidações com medidas de densidade negativas em seu interior, variando de -29 a -83 UH, e opacidades em vidro fosco localizadas no lobo superior do pulmão direito e nos lobos inferiores, com predomínio nos segmentos posteriores. O diagnóstico foi feito através do lavado bronco-alveolar, que evidenciou a presença do material oleoso. O paciente foi orientado a interromper o uso de laxativos oleosos e não retornou para o controle ambulatorial.
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Baron SE, Haramati LB, Rivera VT. Radiological and Clinical Findings in Acute and Chronic Exogenous Lipoid Pneumonia. J Thorac Imaging 2003; 18:217-24. [PMID: 14561906 DOI: 10.1097/00005382-200310000-00002] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Shira E Baron
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467, USA
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Abad Fernández A, de Miguel Díez J, López Vime R, Gómez Santos D, Nájera Botello L, Jara Chinarro B. [Lipoid pneumonia related to workplace exposure to paint]. Arch Bronconeumol 2003; 39:133-5. [PMID: 12622973 DOI: 10.1016/s0300-2896(03)75340-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A 49-year-old man with no known history of pulmonary disease was treated at our hospital after observation of an interstitial pattern on a chest film. The patient was a smoker and professional painter. Computed tomography of the chest showed a diffuse bilateral ground-glass pattern. The lung biopsy showed intra-alveolar lipid accumulation in the form of vacuoles of varying sizes surrounded by numerous focally multinucleated macrophages, establishing a definitive diagnosis of exogenous lipoid pneumonia. Given the patient's profession, he was recommended to avoid workplace exposure to paraffins and oily sprays. The clinical course was favorable after exposure was stopped, with improved lung function and symptoms.
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Affiliation(s)
- A Abad Fernández
- Servicio de Neumología. Hospital Universitario de Getafe. Madrid. Spain.
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Kjeldsberg KM, Oh K, Murray KA, Cannon G. Radiographic approach to multifocal consolidation. Semin Ultrasound CT MR 2002; 23:288-301. [PMID: 12465686 DOI: 10.1016/s0887-2171(02)90018-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Consolidation in the lung is seen on radiographs or computed tomography (CT) as increased areas of attenuation that obscure the underlying pulmonary vasculature. There are numerous causes of multifocal consolidative opacities. If the symptoms are acute (days to weeks), the most common causes include edema, pneumonia, and hemorrhage. Depending on the patient's history, signs, and symptoms, the less common causes such as radiation pneumonitis or acute eosinophilic syndrome may be considered. If the symptoms are more chronic (weeks to months), the differential may include alveolar proteinosis, neoplasms such as lymphoma or bronchoalveolar cell carcinoma, granulomatous or inflammatory conditions, and lipoid pneumonia. In this article, we review and discuss characteristic radiographic and clinical findings that can aid the radiologist in prioritizing the differential considerations when faced with multifocal parenchymal consolidative disease.
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Affiliation(s)
- Kristina M Kjeldsberg
- Department of Radiology, and the School of Medicine, University of Utah Health Sciences Center, Salt Lake City, UT, USA
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Giménez A, Franquet T, Prats R, Estrada P, Villalba J, Bagué S. Unusual primary lung tumors: a radiologic-pathologic overview. Radiographics 2002; 22:601-19. [PMID: 12006690 DOI: 10.1148/radiographics.22.3.g02ma25601] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although the great majority of lung carcinomas are histologically characterized as adenocarcinoma, squamous cell carcinoma, large cell undifferentiated carcinoma, or small cell carcinoma, a variety of rare benign and malignant lung tumors may sporadically affect the lung. Several nonneoplastic tumorlike lesions are seen infrequently but are also part of the differential diagnosis for lung masses. Conventional radiographic findings, although of limited value in the diagnosis of these entities, should be examined carefully when lung tumors are suspected. Computed tomography (CT) is well suited for making a definitive diagnosis of some disease processes. CT helps determine the location and features of the lesions and depicts associated findings to help document the extent of disease. The differential diagnosis can be narrowed when there are typical CT features (eg, the presence of fat in lipoid pneumonia). Although unusual primary lung tumors are difficult to diagnose on the basis of imaging findings alone because such findings are nonspecific in the majority of cases, cross-sectional imaging can play an important role in the diagnostic work-up of these unusual tumors by delineating their extent and directing the radiologist or bronchoscopist to the appropriate biopsy site.
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Affiliation(s)
- Ana Giménez
- Department of Radiology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Sant Antoni M. Claret 167, 08025 Barcelona, Spain.
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Abstract
Airspace filling process is characterized on CT by the presence of one or more fairly homogeneous areas of consolidation with little or no volume loss. The consolidation may be segmental, subsegmental, lobular, or acinar (10 mm or less in diameter). Poorly defined centrilobular nodules may be associated. The margin of the consolidation usually is poorly defined except in the areas in which the consolidation abuts the pleura. Air-containing bronchi or bronchioles (CT air bronchograms or air bronchiolograms) are seen frequently. Many diseases can present with alveolar filling disorders. Because the HRCT findings overlap among various alveolar filling disorders, it may be impossible to make a definite diagnosis with HRCT findings alone. Integration of HRCT findings including disease pattern and distribution and time factors including evolution and resolution of the disease, however, may enable to narrow differential diagnosis of alveolar filling diseases. Furthermore, clinical and laboratory findings also may provide helpful clues to reach a reasonable diagnosis. The role of HRCT in alveolar filling disorders is not limited to diagnosis. HRCT also plays a useful role in determining the extent of disease and in identifying accompanying abnormalities, and complications of the primary disease.
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Affiliation(s)
- K S Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Franquet T, Giménez A, Rosón N, Torrubia S, Sabaté JM, Pérez C. Aspiration diseases: findings, pitfalls, and differential diagnosis. Radiographics 2000; 20:673-85. [PMID: 10835120 DOI: 10.1148/radiographics.20.3.g00ma01673] [Citation(s) in RCA: 141] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aspiration of different substances into the airways and lungs may cause a variety of pulmonary complications. These disease entities most commonly involve the posterior segment of the upper lobes and the superior segment of the lower lobes. Esophagography and computed tomography (CT) are especially useful in the evaluation of aspiration disease related to tracheoesophageal or tracheopulmonary fistula. Foreign body aspiration typically occurs in children and manifests as obstructive lobar or segmental overinflation or atelectasis. An extensive, patchy bronchopneumonic pattern may be observed in patients following massive aspiration of gastric acid or water. CT is the modality of choice in establishing the diagnosis of exogenous lipoid pneumonia, which can result from aspiration of hydrocarbons or of mineral oil or a related substance. Aspiration of infectious material manifests as necrotizing consolidation and abscess formation. The relatively low diagnostic accuracy of chest radiography in aspiration diseases can be improved with CT and by being familiar with the clinical settings in which specific complications are likely to occur. Recognition of the varied clinical and radiologic manifestations of these disease entities is imperative for prompt, accurate diagnosis, resulting in decreased morbidity and mortality rates.
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Affiliation(s)
- T Franquet
- Department of Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, Avda San Antonio Maria Claret 168, Barcelona 08125, Spain.
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Lee JY, Lee KS, Kim TS, Yoon HK, Han BK, Han J, Chung MP, Kwon OJ. Squalene-induced extrinsic lipoid pneumonia: serial radiologic findings in nine patients. J Comput Assist Tomogr 1999; 23:730-5. [PMID: 10524857 DOI: 10.1097/00004728-199909000-00018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of this work was to demonstrate the initial and follow-up radiologic findings of squalene-induced extrinsic lipoid pneumonia. METHOD Follow-up chest radiographs (n = 9) and high-resolution CT scans (n = 3) as well as initial radiographs (n = 9) and CT scans (n = 8) were obtained in nine patients with squalene-induced extrinsic lipoid pneumonia. The serial radiologic findings were analyzed retrospectively by three chest radiologists, focusing on the pattern and distribution of parenchymal abnormalities. RESULTS The most frequent pattern of parenchymal abnormalities on chest radiograph was areas of ground-glass opacity (n = 9, bilateral 6), followed by consolidation (n = 7, bilateral 3) and poorly defined small nodules (n = 4, bilateral 2). The abnormalities were distributed in the right lower lung (n = 9), left lower lung (n = 6), and right middle lung (n = 6) zones. Initial CT scans (n = 8) demonstrated bilateral areas of ground-glass attenuation (n = 8), poorly defined centrilobular nodules (n = 8), crazy paving (n = 6), and consolidation (n = 3). The abnormalities were distributed in the right middle lobe (n = 8) and in both lower lobes (n = 5). Follow-up chest radiograph (n = 9) showed complete disappearance (n = 2) and decrease (n = 7) in the extent of the parenchymal abnormalities. Follow-up CT scans (n = 3) demonstrated decrease (n = 2) and no change (n = 1) in the extent of the abnormalities. CONCLUSION Squalene-induced extrinsic lipoid pneumonia most commonly appears as areas of ground-glass attenuation mixed with poorly defined centrilobular nodules and crazy paving on CT, being distributed mainly in the right middle and both lower lobes. The lesions are indolent and remain after cessation of squalene ingestion.
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Affiliation(s)
- J Y Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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32
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Seo JB, Im JG, Kim WS, Seong CK, Song JW, Chung JH. Shark liver oil-induced lipoid pneumonia in pigs: correlation of thin-section CT and histopathologic findings. Radiology 1999; 212:88-96. [PMID: 10405726 DOI: 10.1148/radiology.212.1.r99jl0788] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate sequential changes in thin-section computed tomographic (CT) findings after inducement of lipoid pneumonia and provide the histopathologic bases of these findings. MATERIALS AND METHODS Shark liver oil was administered to 12 sites in seven pigs. Thin-section CT scans were obtained within 1 hour and at 1 week, 2 weeks, 4 weeks, 8 weeks, 12 weeks, and 16 weeks after oil administration. Scans were assessed for opacity, distribution, location at the lobular level, extent, and volume of the lesions. The CT number in consolidation areas also was measured. Findings at CT were correlated with those in the histopathologic specimens. RESULTS Diffuse ground-glass opacity was noted on all immediately obtained scans. The opacity of the lesions was highest at 1 week; then it decreased gradually to an area of ground-glass opacity. The extent and volume of the lesions decreased at follow-up CT. Histopathologically, the lesions showed a lobular distribution sharply demarcated from the normal lungs. The lobules of decreased volume showed residual thickening of the alveolar walls with bronchiolectasis and mild collagen deposition of the interlobular septa. Pathologic examination of the low-attenuating consolidation area at CT revealed evidence of partial aeration. CONCLUSION Thin-section CT findings of lipoid pneumonia include ground-glass opacity and airspace consolidation, followed by complete or incomplete resolution with volume loss and septal thickening. Low-attenuating consolidation at CT does not always indicate the presence of fat.
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Affiliation(s)
- J B Seo
- Department of Radiology, Seoul National University College of Medicine, South Korea
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Abstract
A report of a cat with a true diaphragmatic hernia in which only falciform fat had herniated is presented. The lesion was misinterpreted as a pulmonary mass. Additional radiographic studies which may have been of diagnostic benefit are briefly discussed.
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Affiliation(s)
- A K Voges
- Department of Small Animal Clinical Sciences, University of Florida, College of Veterinary Medicine, Gainesville 32610-0126, USA
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Affiliation(s)
- J K Dawson
- St Helens Hospital, Department of Rheumatology, Merseyside, UK
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Abstract
Exogenous lipoid pneumonia results from the aspiration or inhalation of fatty substances, such as mineral oil found in laxatives or nasal medications containing liquid paraffin. We present standard and lipid-sensitive (Chemical-shift) MR findings in a patient with histologically confirmed lipoid pneumonia. The loss of signal intensity in an area of airspace disease on opposed-phase imaging was considered specific for the presence of lipid.
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Affiliation(s)
- J E Cox
- Department of Radiology, Bowman Gray School of Medicine, Wake Forest University, Winstom-Salem, NC 27157-1088, USA
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