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Aurangabadkar GM, Choudhary SS, Khan SM. Lipoid Pneumonia Secondary to Diesel Aspiration: An Occupational Hazard. Cureus 2024; 16:e58509. [PMID: 38765374 PMCID: PMC11101980 DOI: 10.7759/cureus.58509] [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: 03/07/2024] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Lipoid pneumonia is defined as a type of pneumonia that occurs as a result of inhalation of either endogenous or exogenous lipid-containing products in the lungs. We present the case of a 55-year-old male patient who presented with chief complaints of cough with blood-tinged sputum, right-sided chest pain, dyspnea, and fever for two days. The patient gave a history of working as a mechanic in an automobile garage and reported an episode of accidental aspiration of diesel during diesel siphoning at the workplace. A chest X-ray and computed tomography (CT) scan of the chest were done, which revealed right-sided lower lobe consolidation. The patient was admitted and started on intravenous antibiotics, corticosteroids, and inhaled bronchodilators, along with oxygen support. A bronchoscopy was done, which revealed the presence of thick mucoid secretions in the right lower lobe bronchus. The patient was discharged after 10 days with stable vitals and was advised to have regular follow-ups to monitor for any long-term pulmonary complications.
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Affiliation(s)
- Gaurang M Aurangabadkar
- Respiratory Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed University), Nagpur, IND
| | - Sumer S Choudhary
- Respiratory Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed University), Nagpur, IND
| | - Shafee M Khan
- Respiratory Medicine, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed University), Nagpur, IND
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2
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Yuen CS, Zhu T, Chu SHC. A rare case of lipoid pneumonia mimicking lung malignancy on radiological imaging: A case report. Respirol Case Rep 2023; 11:e01220. [PMID: 37795339 PMCID: PMC10546085 DOI: 10.1002/rcr2.1220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023] Open
Abstract
Lipoid pneumonia is a rare benign lung disease pathologically characterized by the presence of lipids in the alveoli. It may mimic lung malignancy on radiological imaging. In this case report we present a case of lipoid pneumonia that radiologically manifested as a lung mass and summarize the typical investigation findings and the management of the disease from the literature review to serve as a reminder of and refresh our knowledge of this rare disease entity.
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Affiliation(s)
- Chi Sum Yuen
- Department of Cardiothoracic SurgeryQueen Mary HospitalHong Kong
| | - Tong Zhu
- Department of Cardiothoracic SurgeryQueen Elizabeth HospitalHong Kong
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3
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Yang S, Wu S, Xu J, Lin Y, Huang Z, Chen X, Xu Q, Chen D, Lu C. The effect of therapeutic bronchoalveolar lavage in combination with glucocorticoids on children with acute exogenous lipoid pneumonia. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:255-262. [PMID: 36807506 PMCID: PMC10113277 DOI: 10.1111/crj.13575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/06/2022] [Accepted: 12/18/2022] [Indexed: 02/21/2023]
Abstract
BACKGROUND Exogenous lipoid pneumonia (ELP) is a rare disease caused by the inhalation of oily materials in the alveoli with the pathological characterization by the presence of laden-lipid macrophages in the respiratory specimens. At present, the treatment norm for ELP has not well defined, and so the aim of this study is to evaluate the effect of bronchoalveolar lavage in combination with glucocorticoids on children with ELP. METHODS AND MATERIALS We retrospectively reviewed 17 children with a confirmed history of exogenous oily materials aspiration, admitted to the First Affiliated Hospital of Guangzhou Medical University from June 2012 to December 2021. Clinical features, blood investigations, tomographic evaluations, therapeutic bronchoalveolar lavage and glucocorticoids use were carried out at the beginning of therapy and throughout a follow-up period. RESULTS The included children are the median age of 2 years. Fever, dypnea and tachypnea were the most common symptoms. The most common radiological features were airspace consolidations (15, 93.75%). Chest CT scans showed areas of consolidation with air bronchogram (15, 93.75%), poorly defined centrilobular nodules (13, 81.25%), areas of ground-glass attenuation (11, 68.75%) and 'crazy-paving' pattern (6, 37.5%) in the both lower, right middle lung lobes. Neutrophil percentage of peripheral blood and bronchoalveolar lavage fluid exhibited a significantly higher than the normal range. After treatment with multiple bronchoalveolar lavages and local administration of budesonide during the hospital stay, taken by oral prednisolone (1 ~ 2 mg/kg) after discharge, all of children became asymptomatic and presented normal radiological imagings in the follow-up period. CONCLUSION The most frequently findings in the CT scan of ELP were consolidations and ground-glass attenuation in the both lower and right middle lung lobes. Multiple bronchoalveolar lavages in combination with oral prednisolone for children who had a confirmed history of exogenous oily substances ingestion were an efficient and safe for the clearance of oily materials from the lung and the prevention of fibrosis. This strategy contributed to reducing the damage of ELP in children patients.
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Affiliation(s)
- Sen Yang
- Department of Pediatrics, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shangzhi Wu
- Department of Pediatrics, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiaxing Xu
- Department of Pediatrics, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuneng Lin
- Department of Pediatrics, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhanhang Huang
- Department of Pediatrics, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaowen Chen
- Department of Pediatrics, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qingyun Xu
- Department of Pediatrics, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Dehui Chen
- Department of Pediatrics, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Chengyu Lu
- Department of Pediatrics, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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4
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Jebastin Thangaiah J, Booth CN, Brainard JA, Elsheikh TM, Reynolds JP, Ondrejka SL, Thilagar BP, Mukhopadhyay S, Doxtader EE. Oil Red O Staining of Pulmonary Macrophages in Bronchoalveolar Lavage Specimens Is Not Specific for Vaping-Associated Lung Injury. Am J Clin Pathol 2022; 158:723-729. [DOI: 10.1093/ajcp/aqac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/22/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Oil Red O (ORO) positivity in bronchoalveolar lavage (BAL) fluid macrophages in the setting of e-cigarette, or vaping, product use–associated acute lung injury (EVALI) has been frequently requested by clinicians based on rare reports and subsequent US Centers for Disease Control and Prevention guidelines. The aim of this study was to determine the specificity of ORO staining in BAL specimens with disease states other than EVALI.
Methods
Consecutive BAL specimens (October-December 2019) were stained with ORO. The lipid-laden macrophage index (LLMI) was calculated for each case.
Results
We studied BAL samples from 50 patients. Indications for BAL were surveillance bronchoscopy for lung transplantation (27/50), suspected infection (12/50), sarcoidosis/suspected sarcoidosis (3/50), nodules or ground-glass opacities (3/50), hemoptysis (2/50), asthma or eosinophilic pneumonia (2/50), and idiopathic pulmonary fibrosis (1/50). ORO staining was seen in BAL fluid macrophages in 45 of 50 cases (focal in 18, moderate in 23, diffuse in 4); LLMI ranged from 0 to 218. Using a threshold of LLMI of 85 or higher as positive, ORO was positive in 7 of 50 (14%) cases (range, 85-218).
Conclusions
ORO staining in BAL fluid macrophages is not specific for EVALI. Even when an LLMI of 85 or higher is used as a threshold for positivity, ORO positivity occurs in a significant subset of non–vaping-related cases.
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Affiliation(s)
| | - Christine N Booth
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | - Jennifer A Brainard
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | - Tarik M Elsheikh
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | | | - Sarah L Ondrejka
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | - Bright P Thilagar
- Division of General Internal Medicine , Mayo Clinic, Rochester, MN , USA
| | - Sanjay Mukhopadhyay
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
| | - Erika E Doxtader
- Pathology and Laboratory Medicine Institute , Cleveland Clinic, Cleveland, OH , USA
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5
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Friedrich J, Michels B, Lohfink-Schumm S, Mackert HI, Bargon J. [Cough and Exertional Dyspnoea after Oily Mentholine Inhalation]. Pneumologie 2021; 76:272-274. [PMID: 34348411 DOI: 10.1055/a-1545-3214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A 48-year-old-male presented with a five-week history of non-productive cough and exertional dyspnoea. A pulmonary function test showed a mild diffusion disorder. A CT scan revealed an atypical pneumonia with bipulmonary consolidations, which were accentuated in the right upper lobe. The transbronchial biopsy showed lipid-loaded macrophages. These findings confirmed the diagnosis of a lipoid pneumonia, which developed in the context of inhalation of substances containing menthol. After discontinuation of the causative agent and high-dose steroid administration the symptoms were reversible within a few weeks.
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Jeelani HM, Sheikh MM, Sheikh B, Mahboob H, Bharat A. Exogenous Lipoid Pneumonia Complicated by Mineral Oil Aspiration in a Patient With Chronic Constipation: A Case Report and Review. Cureus 2020; 12:e9294. [PMID: 32832291 PMCID: PMC7437133 DOI: 10.7759/cureus.9294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Exogenous lipoid pneumonia is a rare and frequently misdiagnosed lung disease. It occurs as an inflammatory reaction secondary to either aspiration or inhalation of lipids. Our patient had a history significant for recurrent pneumonia and the use of mineral oil for chronic constipation. A chest computed tomography showed multifocal consolidative opacities with areas of low attenuation, highly suspicious of exogenous lipid pneumonia. The diagnosis was confirmed with combined bronchoalveolar lavage and transbronchial lung biopsy that showed lipid-laden macrophages consistent with exogenous lipoid pneumonia. After thorough medication review, apart from mineral oil, no other contributing factors were found. A diagnosis of exogenous lipoid pneumonia associated with the use of mineral oil made and successfully managed by stopping the offending agent and supportive antibiotics.
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Affiliation(s)
| | | | - Belaal Sheikh
- Internal Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, USA.,Internal Medicine, Chicago Medical School, North Chicago, USA
| | - Hafiz Mahboob
- Pulmonary and Critical Care Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
| | - Anchit Bharat
- Internal Medicine, Indiana University Health Ball Memorial Hospital, Muncie, USA
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7
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Mukhopadhyay S, Mehrad M, Dammert P, Arrossi AV, Sarda R, Brenner DS, Maldonado F, Choi H, Ghobrial M. Lung Biopsy Findings in Severe Pulmonary Illness Associated With E-Cigarette Use (Vaping). Am J Clin Pathol 2020; 153:30-39. [PMID: 31621873 DOI: 10.1093/ajcp/aqz182] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this report is to describe the lung biopsy findings in vaping-associated pulmonary illness. METHODS Lung biopsies from eight patients with vaping-associated pulmonary illness were reviewed. RESULTS The biopsies were from eight men (aged 19-61 years) with respiratory symptoms following e-cigarette use (vaping). Workup for infection was negative in all cases, and there was no evidence for other etiologies. Imaging showed diffuse bilateral ground-glass opacities in all patients. Most recovered with corticosteroid therapy, while one died. Lung biopsies (seven transbronchial, one surgical) showed acute lung injury, including organizing pneumonia and/or diffuse alveolar damage. Common features were fibroblast plugs, hyaline membranes, fibrinous exudates, type 2 pneumocyte hyperplasia, and interstitial organization. Some cases featured a sparse interstitial chronic inflammatory infiltrate. Although macrophages were present within the airspaces in all cases, this feature was not prominent, and findings typical of exogenous lipoid pneumonia were absent. CONCLUSIONS The histopathology of acute pulmonary illness related to e-cigarette use (vaping) is characterized by acute lung injury patterns, supporting the contention that vaping can cause severe lung damage.
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Affiliation(s)
| | - Mitra Mehrad
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Pedro Dammert
- Kent Pulmonary Associates, Dover, DE
- Bayhealth Medical Center, Dover, DE
| | | | | | | | - Fabien Maldonado
- Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Humberto Choi
- Respiratory Institute, Cleveland Clinic, Cleveland, OH
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Mallol C, Espada Y, Lloret A, Altuzarra R, Anselmi C, Novellas R. Dystrophic mineralisation in chronic exogenous lipid pneumonia in cats. JFMS Open Rep 2019; 5:2055116919850255. [PMID: 31205738 PMCID: PMC6537269 DOI: 10.1177/2055116919850255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Case series summary Exogenous lipid pneumonia with mineralisation of the lung parenchyma was diagnosed in three cats with radiographs, CT and/or bronchoalveolar lavage cytological findings. All three cats had a common clinical history of chronic constipation and long-term forced oral administration of mineral oil. All three cases showed radiographic findings compatible with aspiration pneumonia, with an alveolar pattern in the ventral part of the middle and/or cranial lung lobes. Minor improvement of the radiographic lung pattern in the follow-up studies was seen in two cats, and a miliary ‘sponge-like’ mineralised pattern appeared in the previously affected lung lobes months to years after the diagnosis. In one cat, patchy fat-attenuating areas in the consolidated lung lobes were present on thoracic CT. Cases 1 and 2 showed respiratory signs at the initial presentation, while in case 3 the radiographic findings were incidental and the cat had never exhibited respiratory signs. Relevance and novel information This is the first report to describe dystrophic mineralisation of the lung in exogenous lipid pneumonia and also the first to describe the CT features in cats. Exogenous lipid pneumonia should be included in the differential diagnosis in cases of miliary ‘sponge-like’ mineral opacities in the dependent part of the lung lobes on thoracic radiographs or CT in cats, especially in cases of chronic constipation, previously exposed to mineral oil.
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Affiliation(s)
- Claudia Mallol
- Servei de diagnòstic per la imatge, Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Yvonne Espada
- Servei de diagnòstic per la imatge, Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.,Departament de Medicina i Cirurgia Animals, Facultat de Veterinària de la Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Albert Lloret
- Servei de medicina interna, Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Raúl Altuzarra
- Servei de diagnòstic per la imatge, Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Carlo Anselmi
- Servei de diagnòstic per la imatge, Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Rosa Novellas
- Servei de diagnòstic per la imatge, Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.,Departament de Medicina i Cirurgia Animals, Facultat de Veterinària de la Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
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9
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Cha SI, Choi SH, Kim HJ, Kim YJ, Lim JK, Yoo SS, Lee SY, Lee J, Kim CH, Park JY. Clinical and radiological manifestations of lipoid pneumonia according to etiology: Squalene, omega-3-acid ethyl esters, and idiopathic. CLINICAL RESPIRATORY JOURNAL 2019; 13:328-337. [PMID: 30821081 DOI: 10.1111/crj.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/26/2019] [Accepted: 02/24/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Clinical manifestations of lipoid pneumonia (LP) vary depending on the causative agents or underlying causes. The aim of the present study was to investigate the clinical and radiological features of LP, classified according to etiologic agents. METHODS The clinico-radiological characteristics of LP patients were retrospectively compared among groups: exogenous versus idiopathic and squalene versus omega-3-acid ethyl esters (O-3-AEE) versus idiopathic. Idiopathic group was defined as LP with no proven or reported etiological evidence. RESULTS Twenty-two patients met the diagnostic criteria for LP: squalene (9 [41%]), O-3-AEE (6 [27%]), olive oil (1 [5%]), and idiopathic (7 [32%]). Compared with the exogenous group, the idiopathic group showed a higher recurrence rate; higher frequencies of bronchial anthracofibrosis (BAF) and bronchoalveolar lavage (BAL) lymphocytosis; and a higher rate of crazy-paving pattern and lower rate of consolidation on computed tomography scan. In three-group tests, compared with the O-3-AEE group, the squalene group exhibited a significantly higher percentage of neutrophils and a higher rate of right middle lobe (RML) involvement. CONCLUSIONS In comparison with the exogenous group, the idiopathic group demonstrated BAL lymphocytosis, higher rates of recurrence and BAF, and a higher rate of crazy-paving pattern. Compared with the O-3-AEE group, the squlaene group showed a higher percentage of BAL neutrophils and predominant RML involvement.
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Affiliation(s)
- Seung-Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Sun Ha Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Hyun Jung Kim
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Yeon Jae Kim
- Department of Internal Medicine, Daegu Fatima Hospital, Daegu, South Korea
| | - Jae-Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Seung-Soo Yoo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Shin-Yup Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Chang-Ho Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jae-Yong Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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10
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Chen YJ, Hsu CC, Chen KT. Hydrocarbon pneumonitis following fuel siphonage: A case report and literature review. World J Emerg Med 2019; 10:69-74. [PMID: 30687441 DOI: 10.5847/wjem.j.1920-8642.2019.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND People sometimes siphon fuel to fill their tanks. However, this is a potentially dangerous procedure and may cause hydrocarbon pneumonitis. We present the case of a patient with severe hydrocarbon pneumonitis after siphoning fuel. The patient underwent artificial ventilation and was admitted to hospital for 97 days. METHODS We review the relevant literature for a better understanding of clinical features and management strategies for hydrocarbon pneumonitis following fuel siphonage. RESULTS We reviewed 15 articles, which included 3 original articles and 12 case reports that reported the clinical features of fuel siphonage. In addition, we added our presented case for data analysis. A total of 40 cases were included in this review. The literature review found that hydrocarbon pneumonitis caused by fuel siphonage occurs worldwide and that most patients (80%) became symptomatic within 1 day of aspiration. Cough (70%), chest pain (62.5%), dyspnoea (55%), and fever (52.5%) presented in more than half of all patients. The right middle lobe (80%) was the predominantly involved lung field; more than one-third of patients (36.7%) showed the involvement of two lobes. CONCLUSION Patient history, computed tomographic scans of the chest, and bronchoalveolar lavage are the commonly used diagnostic tools. Supportive care remains the foundation of treatment, whereas antibiotics, steroids, and bronchoalveolar lavage are practical therapies. Patients' clinical improvement precedes the resolution of lesions on chest X-ray. Most complications arise from pulmonary lesions. The prognosis of patients suffering from hydrocarbon pneumonitis following fuel siphonage might be improved by accurate diagnosis and appropriate care.
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Affiliation(s)
- Yi-Jung Chen
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan, China
| | - Chien-Chin Hsu
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan, China.,Department of Biotechnology, Southern Tainan University of Technology, Tainan, Taiwan, China
| | - Kuo-Tai Chen
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan, China.,Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, China
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11
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Marangu D, Pillay K, Banderker E, Gray D, Vanker A, Zampoli M. Exogenous lipoid pneumonia: an important cause of interstitial lung disease in infants. Respirol Case Rep 2018; 6:e00356. [PMID: 30094029 PMCID: PMC6079933 DOI: 10.1002/rcr2.356] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/29/2018] [Accepted: 07/13/2018] [Indexed: 11/10/2022] Open
Abstract
Exogenous lipoid pneumonia (ELP), an important cause of interstitial lung disease, often goes unrecognized. We conducted a retrospective study of children with histologically confirmed ELP at Red Cross Children's Hospital, South Africa. Twelve children of Zimbabwean heritage aged 2.1-10.8 months were identified between 2012 and 2017. Repeated oral administration of plant-based oil for cultural reasons was reported by 10 of 11 caregivers. Cough (12/12), tachypnoea (11/12), hypoxia (9/12), and diffuse alveolar infiltrates on chest radiography (12/12) were common at presentation. Chest computed tomography revealed ground-glass opacification with lower zone predominance (9/9) and interlobular septal thickening (8/9). Bronchoalveolar lavage specimens appeared cloudy/milky, with abundant lipid-laden macrophages and extracellular lipid on Oil-Red-O staining (12/12), with polymicrobial (6/12) and Mycobacterium abscessus (2/12) co-infection. Antibiotics, systemic corticosteroids, and therapeutic lavage were interventions in all eight and five patients, respectively. Clinicians should consider ELP in children with non-resolving pneumonia in settings with similar practices.
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Affiliation(s)
- Diana Marangu
- Department of Paediatrics and Child HealthUniversity of NairobiNairobiKenya
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - Komala Pillay
- Division of Pathology, Department of Paediatrics and Child HealthUniversity of Cape TownCape TownSouth Africa
| | - Ebrahim Banderker
- Division of Radiology, Department of Paediatrics and Child HealthUniversity of Cape TownCape TownSouth Africa
| | - Diane Gray
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - Aneesa Vanker
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - Marco Zampoli
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
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12
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Osman GA, Ricci A, Terzo F, Falasca C, Giovagnoli MR, Bruno P, Vecchione A, Raffa S, Valente S, Torrisi MR, De Dominicis C, Giovagnoli S, Mariotta S. Exogenous lipoid pneumonia induced by nasal decongestant. CLINICAL RESPIRATORY JOURNAL 2016; 12:524-531. [PMID: 27717235 DOI: 10.1111/crj.12557] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 07/20/2016] [Accepted: 08/12/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Lipoid pneumonia is a clinical condition that may be initially asymptomatic or confused with an infectious or malignant lung disease. OBJECTIVES We report four cases of this pathological condition. METHODS The first case concerned an 85-year old woman with bilateral confluent pulmonary opacities, ground-glass type. Diagnosis was based on the cytology of the bronchoalveolar lavage (BAL) fluid followed by its ultrastructural examination. The second case was a 47-year-old man with an isolated pulmonary nodule, which was surgically removed; the diagnosis of lipoid pneumonia was formulated on the basis of the histological and electron microscopy examination. The third case concerned a 73-year-old woman, with bilateral hypodense areas at the bases of the lungs where FDG PET/CT scan showed an increased uptake. Diagnosis was formulated by BAL cytology and electron microscopy examination. The fourth case was a 69-year-old man, who performed a virtual colonoscopy for diverticulosis putting in evidence a round mass (3 cm in diameter) with two small peripheral nodules, located in the pulmonary left lower lobe. The histopathological examination of transthoracic biopsy confirmed a lipoid pneumonia. RESULTS AND CONCLUSION In all four cases, it was put in evidence a prolonged use of a nasal decongestant containing mineral oils. In literature, the most cases described are characterized by a subclinical evolution and were presented as ground glass opacities which evolve, in the later phases, in an interstitial involvement or in a peripheral mass, simulating a lung tumour.
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Affiliation(s)
- Giorgia A Osman
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Alberto Ricci
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Fabrizio Terzo
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Carlo Falasca
- UOD Cytopathology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Maria R Giovagnoli
- UOD Cytopathology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Pierdonato Bruno
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Andrea Vecchione
- Division of Pathology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Salvatore Raffa
- UO of Cellular Diagnostics, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Sabatino Valente
- UO of Cellular Diagnostics, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Maria R Torrisi
- UO of Cellular Diagnostics, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | | | - Simonetta Giovagnoli
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
| | - Salvatore Mariotta
- Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy
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Alvarado A, Arce I. Metabolic Functions of the Lung, Disorders and Associated Pathologies. J Clin Med Res 2016; 8:689-700. [PMID: 27635172 PMCID: PMC5012236 DOI: 10.14740/jocmr2668w] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2016] [Indexed: 01/04/2023] Open
Abstract
The primary function of the lungs is gas exchange. Approximately 400 million years ago, the Earth's atmosphere gained enough oxygen in the gas phase for the animals that emerged from the sea to breathe air. The first lungs were merely primitive air sacs with a few vessels in the walls that served as accessory organs of gas exchange to supplement the gills. Eons later, as animals grew accustomed to a solely terrestrial life, the lungs became highly compartmentalized to provide the vast air-blood surface necessary for O2 uptake and CO2 elimination, and a respiratory control system was developed to regulate breathing in accordance with metabolic demands and other needs. With the evolution and phylogenetic development, lungs were taking a variety of other specialized functions to maintain homeostasis, which we will call the non-respiratory functions of the lung and that often, and by mistake, are believed to have little or no connection with the replacement gas. In this review, we focus on the metabolic functions of the lung, perhaps the least known, and mainly, in the lipid metabolism and blood-adult lung vascular endothelium interaction. When these functions are altered, respiratory disorders or diseases appear, which are discussed concisely, emphasizing how they impact the most important function of the lungs: external respiration.
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Affiliation(s)
- Alcibey Alvarado
- Internal Medicine and Neumology, Clinica de Diagnostico Medico, San Jose, Costa Rica
| | - Isabel Arce
- Medicine and General Surgery, Medicine School, University of Costa Rica, San Jose, Costa Rica
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Feng Y, Zhao J, Yang Q, Xiong W, Zhen G, Xu Y, Zhang Z, Zhang H. Pulmonary melanoma and "crazy paving" patterns in chest images: a case report and literature review. BMC Cancer 2016; 16:592. [PMID: 27488496 PMCID: PMC4973081 DOI: 10.1186/s12885-016-2630-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/26/2016] [Indexed: 12/19/2022] Open
Abstract
Background In the lung, melanoma is mostly arranged as patterns of multiple nodules, solitary nodules, or miliary invasions. Very rarely, it also displays a “crazy paving” pattern (also described as a “paving stone,” “flagstone,” or “slabstone” pattern), which is rarer still in discrete bilateral nodules. This pattern is considered to be caused by pulmonary alveolar proteinosis, but its association with various diseases is unclear. Case presentation A 60-year-old man was diagnosed with pulmonary melanoma. Computed tomography revealed discrete bilateral nodules surrounded by a “paving” pattern. A literature review found more than 40 types of diseases that have presented with “paving” patterns in the lung—predominantly pulmonary alveolar proteinosis, viral pneumonia, exogenous lipoid pneumonia, bacterial pneumonia, pulmonary alveolar microlithiasis, interstitial pneumonia, ARDS, squalene aspiration pneumonia, radiation pneumonitis, drug-induced pneumonitis, pulmonary leptospirosis, pulmonary hemorrhage, and pulmonary nocardiosis. Conclusions We describe the first case of pulmonary melanoma in the form of discrete bilateral nodules accompanied with a computed tomography paving pattern. Although pulmonary paving patterns are rare, more than 40 diseases reportedly display them; clinicians should consider melanoma of the lung in differential diagnoses for patients who show such a pattern.
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Affiliation(s)
- Yikuan Feng
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jianping Zhao
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qun Yang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Weining Xiong
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Guohua Zhen
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yongjian Xu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhenxiang Zhang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Huilan Zhang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Abstract
OBJECTIVE To analyze the clinical and imagenological characteristics of acute Exogenous lipoid pneumonia (ELP), explore its risk factors, and assess the potential role of multiple bronchoalveolar lavages (BALs) and steroid therapy in the treatment of children with acute ELP. METHODS Between May 2011 and July 2014, 33 pediatric patients with pneumonia caused by aspiration of oil-based substances were admitted to the Guangzhou Women and Children's Medical Center, Guangdong, China. Data on the demographics of these patients, as well as that on clinical presentations, imagenological characteristics, history of ingestion, laboratory observations, treatment protocol, response to therapy, BAL findings, and treatment outcomes were collected. RESULTS The study group consisted of 23 boys (69.7 %) and 10 girls (30.3 %), with ages ranging from 4 mo to 4 y. They were admitted to the hospital 2 h to 13 d after ingesting the oil-based substance. By the time of admission, most patients presented with respiratory distress and other symptoms, including tachypnea (n = 21), cough (n = 25), mild fever (n = 18), progressive dyspnea (n = 12), and pneumorrhagia (n = 5); six patients received mechanical ventilation because of complicated respiratory distress syndrome. The most common laboratory observations were leukocytosis (25 of 33, 75.8 %), neutrophilia (23 of 33, 69.7 %), and anemia (8 of 33, 24.2 %). Serum biochemical examination showed elevated sedimentation rates (24 of 33, 72.7 %), lactate dehydrogenase levels (18 of 33, 54.5 %), and C-reactive protein levels (17 of 33, 51.5 %). The most common finding on computed tomography (CT) scans was areas of consolidation. Within the follow-up duration of 2 wk to 6 mo, all patients with clinical symptoms of ELP experienced remission, and none died. The CT scans of most of the cases were normal by 1 to 3 mo, except for two patients who showed complete improvement 6 mo after treatment. CONCLUSIONS It was found that multiple BALs combined with steroid therapy result in significant improvement of clinical, radiologic, and laboratory parameters in children with acute ELP. Further, some traditional practices may predispose children to ELP, even in the absence of underlying risk factors. Finally, pneumorrhagia and acute respiratory distress syndrome may be the main complications of acute ELP in children.
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Panchabhai TS, Mukhopadhyay S, Sehgal S, Bandyopadhyay D, Erzurum SC, Mehta AC. Plugs of the Air Passages: A Clinicopathologic Review. Chest 2016; 150:1141-1157. [PMID: 27445091 DOI: 10.1016/j.chest.2016.07.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/22/2016] [Accepted: 07/06/2016] [Indexed: 02/07/2023] Open
Abstract
Although mucus is a normal product of the tracheobronchial tree, some diseases of the respiratory tract are characterized by unusually thick (inspissated) forms of mucus that accumulate within the airways. These are known as mucus plugs. The pathologic composition of these plugs is surprisingly diverse and, in many cases, correlates with distinctive clinical, radiologic, and bronchoscopic findings. The best-known conditions that involve mucus plugs are allergic bronchopulmonary aspergillosis, plastic bronchitis, and asthma. Other lung diseases occasionally associated with plugs within the airways include Aspergillus tracheobronchitis, hyper-IgE syndrome, exogenous lipoid pneumonia, pulmonary alveolar proteinosis, and chronic eosinophilic pneumonia. In this review, we describe and illustrate the bronchoscopic, pathologic, and imaging findings in respiratory disorders characterized by mucus plugs or plugs composed of other similar materials. Recognition of the characteristic appearance and differential diagnosis of mucus plugs will hopefully facilitate diagnosis and management of these diseases.
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Affiliation(s)
- Tanmay S Panchabhai
- Norton Thoracic Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ
| | | | - Sameep Sehgal
- Department of Pulmonary Medicine, the Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | | | - Serpil C Erzurum
- Department of Pulmonary Medicine, the Respiratory Institute, Cleveland Clinic, Cleveland, OH; Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Atul C Mehta
- Department of Pulmonary Medicine, the Respiratory Institute, Cleveland Clinic, Cleveland, OH.
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Makrygianni EA, Palamidou F, Kaditis AG. Respiratory complications following hydrocarbon aspiration in children. Pediatr Pulmonol 2016; 51:560-9. [PMID: 26910771 DOI: 10.1002/ppul.23392] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 01/08/2016] [Accepted: 01/13/2016] [Indexed: 11/12/2022]
Abstract
Accidental hydrocarbon ingestion may lead to aspiration and chemical pneumonitis in children. In this review article, the clinical course of hydrocarbon pneumonitis, chest radiographic abnormalities, complications, and treatment interventions are summarized. Most children remain asymptomatic and without complications following ingestion of a hydrocarbon. In approximately 15% of ingestions, aspiration pneumonitis occurs and evolves over the first 6-8 hr presenting with fever, tachypnea, hypoxemia, and tachycardia. A symptom zenith is reached within 48 hr followed by progressive improvement. Up to 5% of pneumonitis cases progress rapidly to acute respiratory failure. Chest radiographic abnormalities develop by 4-8 hr after ingestion, but they are not always predictive of clinical pneumonitis. Patients with history of hydrocarbon ingestion should be monitored for 6-8 hr in the emergency department and a chest radiogram should be obtained at the end of the observation period. Spontaneous or induced emesis and gastric lavage have been related to aspiration pneumonitis. Children who are symptomatic are admitted to the hospital for cardiorespiratory status monitoring and supportive care. Approximately 90% of hospitalized patients have a benign clinical course. Increased work of breathing with or without altered sensorium and seizures are indications for admission to the intensive care unit. Hypoxemia unresponsive to supplemental oxygen and/or severe central nervous system involvement require mechanical ventilation. Corticosteroids do not seem to offer any benefit and antibiotics are administered in cases of bacterial superinfection. Pneumatoceles may become evident after the first 6-10 days of symptoms on follow-up chest radiograms and they resolve up to 6 months later. Pediatr Pulmonol. 2016;51:560-569. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Evanthia A Makrygianni
- Pediatric Pulmonology Unit, First Department of Pediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Fani Palamidou
- Pediatric Pulmonology Unit, First Department of Pediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
| | - Athanasios G Kaditis
- Pediatric Pulmonology Unit, First Department of Pediatrics, University of Athens School of Medicine and Aghia Sophia Children's Hospital, Athens, Greece
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18
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Suspected Aerogenous Lung Metastases From Nasopharyngeal Cancer. Ann Thorac Surg 2016; 101:e157-9. [PMID: 27106465 DOI: 10.1016/j.athoracsur.2015.10.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 10/16/2015] [Accepted: 10/26/2015] [Indexed: 11/21/2022]
Abstract
A 44-year-old man experiencing repeated episodes of epistaxis and respiratory aspiration was diagnosed with nasopharyngeal cancer. Although the tumor completely disappeared after chemoradiation, six pulmonary nodules developed in the right lower lobe within a year. Right lower lobectomy was performed. All nodules were metastases of the nasopharyngeal cancer. Surgery was performed despite a poor prognosis, and there has been no recurrence 12 years postoperatively. Aerogenous metastases were suggested owing to right lower lobe localization and the patient's symptoms and prolonged survival. The possibility of aerogenous spread and the efficacy of local therapy should be further studied.
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Rea G, Lassandro F, Valente T. Exogenous lipoid pneumonia in laryngectomy patients: Is ground glass opacity/crazy paving pattern an organizing pneumonia reaction that can predict poor outcome? Arch Bronconeumol 2016; 52:438-9. [PMID: 26879803 DOI: 10.1016/j.arbres.2015.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/27/2015] [Accepted: 11/30/2015] [Indexed: 01/15/2023]
Affiliation(s)
- Gaetano Rea
- Servicio de Radiología, Hospital Monaldi, Nápoles, Italia.
| | | | - Tullio Valente
- Servicio de Radiología, Hospital Monaldi, Nápoles, Italia
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20
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Chronic Lipoid Pneumonia in a 9-Year-Old Child Revealed by Recurrent Chest Pain. Case Rep Pediatr 2015; 2015:402926. [PMID: 26078902 PMCID: PMC4454704 DOI: 10.1155/2015/402926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 05/18/2015] [Indexed: 11/18/2022] Open
Abstract
Lipoid pneumonia in children is a rare disorder due to accumulation of fatty oily material in the alveoli and usually associated with an underlying condition. In absence of obvious context, diagnosis remains difficult with nonspecific clinical and radiological features. We report the first case of voluntary chronic aspiration of olive oil responsible for exogenous lipoid pneumonia, in a previously healthy 9-year-old boy. Clinical presentation was atypical; LP was revealed by isolated chest pain. We discuss radiological and bronchial alveolar lavage characteristics suggestive of lipoid pneumonia. Conclusion. Lipoid pneumonia is a disease to be reminded of in children, which can occur with original findings in terms of etiology and clinical presentation.
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Abstract
Aspiration of foreign matter into the airways and lungs can cause a wide spectrum of pulmonary disorders with various presentations. The type of syndrome resulting from aspiration depends on the quantity and nature of the aspirated material, the chronicity, and the host responses. Aspiration is most likely to occur in subjects with a decreased level of consciousness, compromised airway defense mechanisms, dysphagia, gastroesophageal reflux, and recurrent vomiting. These aspiration-related syndromes can be categorized into airway disorders, including vocal cord dysfunction, large airway obstruction with a foreign body, bronchiectasis, bronchoconstriction, and diffuse aspiration bronchiolitis, or parenchymal disorders, including aspiration pneumonitis, aspiration pneumonia, and exogenous lipoid pneumonia. In idiopathic pulmonary fibrosis, aspiration has been implicated in disease progression and acute exacerbation. Aspiration may increase the risk of bronchiolitis obliterans syndrome in patients who have undergone a lung transplant. Accumulating evidence suggests that a causative role for aspiration is often unsuspected in patients presenting with aspiration-related pulmonary diseases; thus, many cases go undiagnosed. Herein, we discuss the broadening spectrum of these pulmonary syndromes with a focus on presenting features and diagnostic aspects.
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Affiliation(s)
- Xiaowen Hu
- Department of Respiratory Disease, Anhui Provincial Hospital, Hefei, China
| | - Joyce S Lee
- Department of Medicine, University of California, San Francisco, CA
| | - Paolo T Pianosi
- Pediatric Pulmonology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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Kupeli E, Khemasuwan D, Tunsupon P, Mehta AC. "Pills" and the air passages: a continuum. Chest 2015; 147:242-250. [PMID: 25560862 DOI: 10.1378/chest.14-0531] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Recently, we reported a number of key, common medications that affect the air passages in a variety of fashions. The purpose of this article is to provide a comprehensive review of the literature on the subject, including supportive articles published in languages other than English. The presented information was gathered by a review of the English literature, by cross referencing, and by communication with other interventional pulmonologists. We identified several additional medications causing either direct or systemic effects on the air passages. In this review, we update the clinical presentation, mechanism of injury, diagnosis, and management of the airway complications related to these medications.
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Affiliation(s)
- Elif Kupeli
- Pulmonary Diseases Department, Baskent University School of Medicine, Ankara, Turkey
| | - Danai Khemasuwan
- Pulmonary and Critical Care Medicine Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | | | - Atul C Mehta
- Lerner College of Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH..
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Stathis G, Priftis KN, Moustaki M, Alexopoulou E. Non-resolving Findings in a Long-term Radiographic Follow-up of an Infant with Acute Paraffin Oil Aspiration. J Clin Imaging Sci 2014; 4:2. [PMID: 24678434 PMCID: PMC3952376 DOI: 10.4103/2156-7514.126028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/17/2013] [Indexed: 12/17/2022] Open
Abstract
Acute lipoid pneumonia (LP) in children is a rare disorder caused by the aspiration of oil-based substances and is difficult to diagnose due to non-specific clinical symptoms and radiological findings. We report the case of a 5-month-old male infant with acute LP caused by accidental aspiration of a large amount of mineral oil. We present the imaging findings in the computed tomography scans performed during his hospitalization and focus on the residual abnormalities seen on a scan performed 7-years after the incident. This, to the best of our knowledge, is the longest follow-up report of an acute exogenous LP patient and the only case that demonstrates non-resolving abnormalities in a pediatric patient after a single acute episode of mineral oil aspiration.
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Affiliation(s)
- George Stathis
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, General University Hospital "ATTIKON", Chaidari, GR 124 62, Athens, Greece
| | - Konstantinos N Priftis
- Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, General University Hospital "ATTIKON", Chaidari, GR 124 62, Athens, Greece
| | - Maria Moustaki
- Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, General University Hospital "ATTIKON", Chaidari, GR 124 62, Athens, Greece
| | - Efthymia Alexopoulou
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, General University Hospital "ATTIKON", Chaidari, GR 124 62, Athens, Greece
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Venkatnarayan K, Madan K, Walia R, Kumar J, Jain D, Guleria R. "Diesel siphoner's lung": Exogenous lipoid pneumonia following hydrocarbon aspiration. Lung India 2014; 31:63-6. [PMID: 24669087 PMCID: PMC3960815 DOI: 10.4103/0970-2113.125986] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Kavitha Venkatnarayan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Ritika Walia
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Jaya Kumar
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
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Diffuse Lung Disease. PEDIATRIC CHEST IMAGING 2014. [PMCID: PMC7120093 DOI: 10.1007/174_2014_1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Diffuse lung disease (DLD) comprises a diverse group of disorders characterized by widespread pulmonary parenchymal pathology and impaired gas exchange. While many of these disorders are categorized under the rubric of interstitial lung disease (ILD), some of these disorders involve the airspaces or peripheral airways in addition to, or rather than, the interstitium. Some of these disorders are present primarily in infancy or early childhood, while others that are prevalent in adulthood rarely occur in childhood. This chapter will review the classification of pediatric DLD and the characteristic imaging findings of specific disorders to facilitate accurate diagnosis and guide appropriate treatment of children with these disorders.
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Doubková M, Doubek M, Moulis M, Skřičková J. Exogenous lipoid pneumonia caused by chronic improper use of baby body oil in adult patient. REVISTA PORTUGUESA DE PNEUMOLOGIA 2013; 19:233-6. [PMID: 23830509 DOI: 10.1016/j.rppneu.2013.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 04/10/2013] [Accepted: 05/11/2013] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Exogenous lipoid pneumonia (ELP) is an uncommon condition resulting from aspirating or inhaling fatlike material. These substances elicit a foreign body reaction and proliferative fibrosis in the lung. CASE REPORT We report a case of a 38-year-old woman with bilateral pulmonary infiltration. There were no clinical symptoms of this infiltration at diagnosis. The infiltration was found coincidentally during the pre-operation examination before surgery. A chest computed tomography scan revealed bilateral lung consolidation, particularly in the S6 area on the right side. The transthoracic lung biopsy led to suspicion of ELP. Precise anamnesis confirms the diagnosis of ELP caused by chronic improper use of baby body oil. Two years after discontinuing "baby body oil therapy", a chest CT scan revealed partial regression of pulmonary infiltration. CONCLUSION The diagnosis of exogenous lipoid pneumonia is often difficult as symptoms, signs, and radiographic findings are all rather non-specific. We would like to emphasize the role of precise case history in better identification of ELP.
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Affiliation(s)
- M Doubková
- Department of Pneumology and Phthiseology, Faculty of Medicine and University Hospital, Brno, Czech Republic.
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Abstract
Exogenous lipoid pneumonia is a rare disorder caused by inhalation and/or aspiration of oil-based substances. The confirmed diagnosis of exogenous lipoid pneumonia is difficult, especially in cases for which it is impossible to ascertain a history of inhalation or aspiration. We present a case of exogenous lipoid pneumonia due to aspiration of insecticide, for which the computed tomography findings of fat attenuation within the lesion were helpful in reaching a correct diagnosis.
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Marchiori E, Zanetti G, Fontes FB, Hochhegger B. Optimizing the utility of high-resolution computed tomography in diagnosing exogenous lipoid pneumonia. Heart Lung 2012; 41:207-8; author reply 208-9. [DOI: 10.1016/j.hrtlng.2011.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 10/29/2011] [Indexed: 11/30/2022]
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Athayde Salgado I, Cavalcante Santos C, Victor Salgado J, Consorte Ferraz P, Maria Haidar D, Almeida Pereira H. Exogenous lipoid pneumonia in children: a disease to be reminded of. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1590/s0104-42302012000200006] [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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Harris K, Chalhoub M. Comment on “Optimizing the utility of high-resolution computed tomography in diagnosing exogenous lipoid pneumonia”. Heart Lung 2012. [DOI: 10.1016/j.hrtlng.2011.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Salgado IA, Santos CC, Salgado JV, Ferraz PC, Haidar DM, Pereira HA. Exogenous lipoid pneumonia in children: a disease to be reminded of. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70171-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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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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The crazy-paving pattern: a radiological-pathological correlation. Insights Imaging 2011; 2:117-132. [PMID: 22347941 PMCID: PMC3259383 DOI: 10.1007/s13244-010-0060-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 11/08/2010] [Accepted: 12/16/2010] [Indexed: 02/06/2023] Open
Abstract
The crazy-paving pattern is a linear pattern superimposed on a background of ground-glass opacity, resembling irregularly shaped paving stones. The crazy-paving pattern is initially described as the pathognomonic sign of alveolar proteinosis. Nowadays this pattern is a common finding on high-resolution CT imaging, and can be seen in a number of acute and chronic diseases. The purpose of this paper is to illustrate different diseases that cause this crazy-paving pattern and to correlate the radiological findings from computed tomography with the histopathological findings.
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Guillerman RP. Imaging of Childhood Interstitial Lung Disease. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2010; 23:43-68. [PMID: 22332031 DOI: 10.1089/ped.2010.0010] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Accepted: 03/22/2010] [Indexed: 01/15/2023]
Abstract
The aphorism that children are not little adults certainly applies for the imaging of interstitial lung disease. Acquiring motion-free images of fine pulmonary structures at desired lung volumes is much more difficult in children than in adults. Several forms of interstitial lung disease are unique to children, and some forms of interstitial lung disease encountered in adults rarely, if ever, occur in children. Meticulous attention to imaging technique and specialized knowledge are required to properly perform and interpret chest imaging studies obtained for the evaluation of childhood interstitial lung disease (chILD). This review will address technique recommendations for imaging chILD, the salient imaging findings in various forms of chILD, and the efficacy of imaging in the diagnosis and management of chILD.
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Affiliation(s)
- R Paul Guillerman
- Department of Radiology, Baylor College of Medicine, Singleton Department of Diagnostic Imaging, Texas Children's Hospital , Houston, Texas
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