Lipoid Pneumonia Caused by Esophageal Achalasia

A 59-year-old man presented with esophageal achalasia complicated by lipoid pneumonia. Dysphagia and diffuse ground-glass shadows on computed tomography led to the diagnosis of esophageal achalasia. An analysis of bronchoalveolar lavage (BAL) revealed yellow BAL fluid, with two distinct layers. Oil droplets were observed in the upper layer. Macrophages that phagocytosed lipids were also observed. He was diagnosed with lipoid pneumonia secondary to esophageal achalasia. His lipoid pneumonia improved after peroral endoscopic myotomy because of the reduction in aspiration risk.

[One case of severe exogenous lipoid pneumonia complicated with lung abscess caused by diesel inhalation]

Exogenous lipoid pneumonia is an inflammatory response to the lungs caused by inhaled lipid substances, which is prone to secondary bacterial infection, resulting in the formation of local abscesses, which can be life-threatening in severe cases. This paper reports a case of a 55-year-old patient with diesel aspiration, secondary to Klebsiella pneumoniae (ESBL positive) and Candida glabrata infection resulting in lung abscess formation. He was treated with a variety of antibacterial drugs for anti-infection, non-invasive ventilator ventilation, bronchoalveolar lavage, glucocorticoids, phlegm and other medical treatments. Finally, he underwent middle lobectomy for improvement and was discharged from the hospital, and he recovered well with regular follow-up.

False positive 18FDG PET-CT results due to exogenous lipoid pneumonia secondary to oily drug inhalation: A case report

RATIONALE

Exogenous lipoid pneumonia is a rare condition due to abnormal presence of oily substances in the lungs. It is a rarely known cause for false positive FDG PET-CT results and can sometimes lead to invasive investigations. Searching and finding the source of the oily substance is one of the keys to the diagnosis. Inhalation of oily drugs during snorting has rarely been described.

PATIENT CONCERNS

A patient with well controlled HIV infection was referred for an FDG PET-CT to assess extension of Kaposi's disease, recently removed from his right foot. The patient had no particular symptoms.

DIAGNOSES

Abnormal uptake of FDG was found in a suspicious lung nodule. An experienced radiologist thought the nodule was due to lipoid pneumonia.

INTERVENTIONS

Bronchoalveolar lavage fluid did not contain lipid-laden macrophages but bronchoscopy showed violet lesions resembling Kaposi's disease lesions. Lobectomy was performed after a multidisciplinary discussion.

OUTCOMES

Anatomopathological analysis revealed the nodule was due to lipoid pneumonia. The patient's quality of life did not diminish after the operation and he is still in good health. The source of the oily substance causing lipoid pneumonia was found after the surgery: the patient used to snort oily drugs.

LESSONS

The presence of a suspicious lung nodule possibly due to lipoid pneumonia in a patient with known Kaposi's disease was difficult to untangle and lead to invasive surgery. It is possible that if a source of exogenous lipoid pneumonia had been found beforehand, surgery could have been prevented.

[About an unusual case of lipoid pneumonia]

Lipoid pneumonia, although uncommon, should be considered when patients had a chronic pneumonia. We report a case of a 40-year-old female who presented with a chronic pneumonia. The CT-scan analysis, then the bronchoalveolar lavage, revealed a lipoid pneumonia. This lipoid pneumonia was caused by chronic inhalation of niaoulis vapors. This etiology has not been described in the literature. Alveolar condensation disappeared one month after bronchoalveolar lavage. This suggests that bronchoalveolar lavage may contribute to opacity regression besides exogenous lipid eviction.

Lipoid Pneumonia After Prolonged Inhalation of Clarified Butter Made from the Milk of a Buffalo or Cow (Ghee)

Lipoid pneumonia is a rare form of pneumonia caused by inhalation or aspiration of fat containing substances. It can present acutely or more commonly presents as an insidious onset chronic respiratory illness. It requires a high degree of suspicion with great emphasis on history. It can mimic tuberculosis, malignancy or interstitial lung disease. We report the case of a 31-year-old male with a history of sniffing hydrogenated oil, presenting with a non-resolving pneumonia.

Endogenous lipoid pneumonia in a cachectic patient after brain injury

Endogenous lipoid pneumonia (EnLP) is an uncommon non-life-threatening inflammatory lung disease that usually occurs in patients with conditions such as lung cancers, primary sclerosing cholangitis, and undifferentiated connective tissue disease. Here we report a case of EnLP in a paralytic and cachectic patient with bronchopneumonia after brain injury. A 40-year-old man experienced a severe brain injury in an automobile accident. He was treated for 1 month and his status plateaued. However, he became paralyzed and developed cachexia and ultimately died 145 days after the accident. Macroscopically, multifocal yellowish firm nodules were visible on scattered gross lesions throughout the lungs. Histologically, many foam cells had accumulated within the alveoli and alveolar walls accompanied by a surrounding interstitial infiltration of lymphocytes. The findings were in accordance with a diagnosis of EnLP. Bronchopneumonia was also noted. To our knowledge, there have been few reports of EnLP associated with bronchopneumonia and cachexia after brain injury. This uncommon pathogenesis should be well recognized by clinicians and forensic pathologists. The case reported here should prompt medical staff to increase the nutritional status and fight pulmonary infections in patients with brain injury to prevent the development of EnLP.

[Clinical characteristics of lipid aspiration pneumonia in 16 children]

OBJECTIVE

To investigate clinical characteristics and changes of pulmonary imaging of mineral oil aspiration pneumonia in children.

METHOD

The clinical features, CT findings, and effects of corticosteroid therapy were analyzed in 16 children with mineral oil aspiration pneumonia, who were hospitalized in our hospital from January 2003 to July 2013.

RESULT

All patients with mineral oil aspiration pneumonia had a history of mineral oil administration.Four patients had no clinical manifestations. Ten cases presented fever, and 8 of the 10 patients had fever in 4-8 h after taking mineral oil, and the temperature was between 39-40 °C. There were wheezing in 2 cases, shortness of breath in 6 cases, cyanosis in 1 case, dyspnea in 3 cases, and moaning in 2 cases, chest pain in 1 case, headache and abnormal EEG in 1 case.Six patients had rales in lungs. Peripheral blood white cells increased in 10 cases, and C- reactive protein elevated in 7 patients. Chest CT examination showed abnormal findings in 6 children, and the earliest CT was performed within 2 h after the accident. The rest 10 children got chest X-ray, and 9 of 10 children had abnormal findings. The earliest X-ray was done within 3 h after the accident. And the remaining 1 of 10 children showed no significant changes in the first chest X-ray 2-3 h after the accident until 3 days. All of the patients received corticosteroid and antibiotic treatments, 4 cases underwent bronchoalveolar lavage, 3 patients were given albumin, 6 cases received intravenous immunoglobulin. Three cases delayed in treatment with hormone because of misdiagnosis, and 2 of them had clearly secondary infections. Twelve patients recovered completely from oil aspiration pneumonia after 8 days to 5.5 months.

CONCLUSION

Oil aspiration pneumonia in children occurs in almost all cases after mineral oil aspiration. Pulmonary opacities can be found by chest CT in most patients within 24 hours after mineral oil aspiration. Corticosteroids therapy was effective for patients with exogenous lipid pneumonia, which may inhibit the inflammatory response and possible pulmonary fibrosis.

Lipoid pneumonia--a case of refractory pneumonia in a child treated with ketogenic diet

Lipoid pneumonia (LP) is a chronic inflammation of the lung parenchyma with interstitial involvement due to the accumulation of endogenous or exogenous lipids. Exogenous LP (ELP) is associated with the aspiration or inhalation of oil present in food, oil-based medications or radiographic contrast media. The clinical manifestations of LP range from asymptomatic cases to severe pulmonary involvement, with respiratory failure and death, according to the quantity and duration of the aspiration. The diagnosis of exogenous lipoid pneumonia is based on a history of exposure to oil and the presence of lipid-laden macrophages on sputum or bronchoalveolar lavage (BAL) analysis. High-resolution computed tomography (HRCT) is the imaging technique of choice for evaluation of patients with suspected LP. The best therapeutic strategy is to remove the oil as early as possible through bronchoscopy with multiple BALs and interruption in the use of mineral oil. Steroid therapy remains controversial, and should be reserved for severe cases. We describe a case of LP due to oil aspiration in 3-year-old girl with intractable epilepsy on ketogenic diet. Diagnostic problems were due to non-specific symptoms that were mimicking serious infectious pneumonia. A high index of suspicion and precise medical history is required in cases of refractory pneumonia and fever unresponsive to conventional therapy. Gastroesophageal reflux and a risk of aspiration may be regarded as relative contraindications to the ketogenic diet. Conservative treatment, based on the use of oral steroids, proved to be an efficient therapeutic approach in this case.

Severe lipoid pneumonia following aspiration of machine oil: successful treatment with steroids

Lipoid pneumonia in children follows mineral oil aspiration and may result in acute respiratory failure. Majority of the patients recover without long-term morbidity, though a few may be left with residual damage to the lungs. We report a case of a two-and-a-half-year-old child with persistent lipoid pneumonia following accidental inhalation of machine oil, who was successfully treated with steroids.

Undifferentiated connective tissue disease with pulmonary involvement

Pulmonary involvement in collagen vascular diseases is extremely common. It is usually seen in the well described dyscollagenoses and in mixed connective tissue diseases (MCTD). However, there is a lesser known entity called Undifferentiated Connective Tissue Disease (UCTD) which can also involve the lung. We herein present a case of a young man who was detected to have lung involvement secondary to UCTD.

[Vegetable oil-induced acute respiratory distress syndrome (ARDS) in near drowning: evaluation based on extravascular lung water index]

Lipoid pneumonia usually presents after chronic recurrent ingestion of oily substances or accidental aspiration during "fire-eating" demonstrations. Massive exposure by near drowning extremely rare and potentially fatal. We present here a case of survival after total immersion in oil in her workplace. A 66-year-old woman who nearly drowned in a vat of vegetable oil was admitted as an emergency case with severe hypoxia after rescue. Chest computed tomography (CT) findings showed bilateral ground-glass opacity, consolidation, and the case fulfilled the criteria for acute respiratory distress syndrome (ARDS). Bronchoscopy and bronchoalveolar lavage performed on admission indicated oil droplets and marked neutrophilia (67%), which made us diagnose ARDS induced by lipoid pneumonia. We commenced treatment with pulsed steroids and strictly managed fluid balance under mechanical ventilation. Despite immediate improvement in oxygenation, the value of extravascular lung water index (EVLWI) measured by the PiCCO system consistently remained over 30 ml/Kg through her clinical course. We concluded that lipoid pneumonia is characterized by prolonged elevatation of pulmonary vascular permeability.

[Lipoid pneumonia related to an accidental aspiration of gas-oil]

A 35-year-old non smoker man with no known history of chronic pulmonary disease, was treated at our hospital after accidental aspiration of gas-oil. He had developed an acute lipoid pneumonia in a few hours. Computed tomography of the chest showed a ground-glass pattern in middle lobe; given the immediate epidemiological precedent, it was possible to confirm a definitive diagnosis. One year later the patient is asymptomatic although small signs of acute process remain in the computed tomography.

False-positive FDG-PET scan secondary to lipoid pneumonia mimicking a solid pulmonary nodule

Fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scanning is useful in evaluating suspicious lesions of the lung. Our patient was a 65-year-old woman with a 45-pack-year smoking history who was referred for further evaluation because of a 3 cm x 3 cm solid lung nodule on computed tomography scan of the chest. FDG-PET scan revealed a standard uptake value of 3.2 suggestive of malignancy. The histology of the lung nodule was consistent with lipoid pneumonia, a benign condition frequently associated with inadvertent aspiration or inhalation of oily substances.

Neumonía lipoidea exógena aguda en «comedores de fuego». Descripción de dos casos

Exogenous lipoid pneumonia is a rare disease that has traditionally been considered a chronic condition secondary to continued aspiration or inhalation of fatty substances. An acute form may sometimes appear after a single and massive aspiration of lipid material, being a characteristic accident of street artists or "fire-eaters" that may generate acute respiratory failure. In this paper, we present clinical and radiological signs and outcome of two cases of lipoid pneumonia in "fire-eaters". A few hours after exposure patients may develop fever, cough, chest pain, hemoptysis, pulmonary infiltrates or hypoxemia. While diagnosis of chronic forms may require invasive procedures, recent exposure to fatty substances is a clue for clinical diagnosis in acute forms. Acute forms usually have a good outcome but cases evolving to cavitary pneumonia have been described. Some patients can present with acute respiratory distress syndrome and death. Treatment is based on general supportive measures.

[Exogenous lipoid pneumonia--case report]

Exogenous lipoid pneumonia (ELP) is an infrequent pathology that results from the aspiration or inhalation of exogenous hydrocarbon. The acute form may be seen in cases of accidental aspiration of fatlike material traditionally described in fire-eaters. The authors present the case report of an acutELP in a 19 year-old patient, fire-eater, admitted at the Emergency Room after inhalation of petroleum. By conclusion, some brief considerations on clinical-imagiological aspects of this situation are discussed.

[Exogenous lipoid pneumonia. Presentation of a new case]

Exogenous lipoid pneumonia is a rare disease, secondary to continued aspiration of exogenous lipoid. Usually is a chronic disease, but also an acute form can be produced by massive accidental aspirations of lipidic material. We present a case of chronic lipoid pneumonia secondary to the continued aspiration of "nasal drops ".

[Exogenous lipid pneumonia--a report of four cases]

Exogenous lipoid pneumonia (ELP) is a rare interstitial pulmonary disease caused by aspiration of the oily material. It is known to mimic many pulmonary diseases and causes many diagnostic difficulties. We present four patients with ELP. The clinical picture was very heterogenous. We described these cases to show that the use of the mineral oils may increase the risk of lipoid pnemonia.

[Persistent pneumonia with fever: are laxatives responsible?]

Aspiration of oil into the lung can lead to pneumonia. The degree of severity depends on the quantity and the nature of the oil. We report the case of a 43-year-old woman with no medical history who was hospitalized for suspected infectious pneumonia. Explorations led to the conclusion that aspiration pneumonia was secondary to the ingestion of oil favored by gastroesophageal reflux.

Fatal lipoid pneumonia due to bronco-aspiration of isoparaffin after ingestion of an organophosphate insecticide

A 66-year-old-male patient with a history of depression voluntarily ingested around 400 ml of an insecticide composed of 5% methylparathion, 75% isoparaffin, 8% etoxylated oleic acid, 4% 1,2,4-trimethylbenzene, 6% naphtha, 1% 1,3,5- trimethylbenzene, 0.4% propylbenzene and 0.3% xylene. The patient was conscious and alert at admission. Gastric lavage was performed and activated charcoal administered. There were no clinical symptoms of organophospate ingestion despite reduced concentrations of erythrocyte and plasma cholinesterase. Chest X-ray showed pulmonary infiltrate compatible with bronco-aspiration. The patient evolved to respiratory failure refractory to treatment and died from multiorganic failure 23 days after ingesting the insecticide. The pathological findings included a pulmonary fibrosis in the alveolar spaces which caused enlargement of the intra-alveolar septa. Abundant lipin-laden macrophages were observed within the alveolar spaces. We review the most relevant aspects of cases of fatal lipoid pneumonia and point out that on occasion severe or fatal intoxication is due to the substances accompanying the active ingredients.

[Lipoid pneumonia related to workplace exposure to paint]

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.

[A Mycobacterium abscessus infection complicated with lipoid pneumonia]

A 64-year-old man was admitted to our hospital because of productive cough and fever. Chest radiography on admission revealed air space consolidation in the right middle and lower lung fields and ground-glass opacity in the left middle lung field. He had been constipated for several years and had taken mineral oil for about a year. Sputum smears demonstrated acid bacilli, and cultures disclosed Mycobacterium abscessus. The transbronchial lung biopsy specimen showed granulomatous inflammation and numerous lipoid-laden macrophages in the alveolar spaces. Mycobacteria were present within the mineral oil and lipid-laden macrophages. It is likely that the mineral oil increased the pathogenicity of the mycobacteria.

Fire eater's risk: lipoid pneumonia following aspiration of a liquid hydrocarbon mixture

Acute aspiration of a liquid hydrocarbon mixture by fire eaters may cause severe lipoid pneumonia. The toxic effect of ingested hydrocarbon chains depends on their length and biophysical qualities. We report the case of a patient who accidentally aspirated a hydrocarbon liquid resulting in a lipoid pneumonia. The pathomechanism, diagnostic work-up, and the therapeutic approach are discussed.

[Acute form of eexogenous lipoid pneumonia caused by inhalation of liquid paraffin in a fire-eater]

We report a case of acute exogenous lipoid pneumonia in a 34-year-old-fire-eater. Six hours after inhalation of liquid paraffin, dyspnea, cough, fever, hemoptysis, and chest pain developed in this patient. Chest computed tomography showed nodular infiltrations with ground glass opacities (GGO) in the right middle lobes, GGO alone in the right lower lobes, and consolidations with GGO in the left lower lobes. Lipid-laden alveolar macrophages in bronchoalveolar lavage fluid were detected by lipid staining (Sudan III stain, oil-red-O stain) and transmission electron microscopy. The symptoms and lung infiltrations were improved by treatment with predonisolone, together with antibiotics and urinastatin.

Exogenous lipoid pneumonia following ingestion of liquid paraffin

An asymptomatic patient with exogenous lipoid pneumonia (ELP) due to silent aspiration of liquid paraffin ingested as a lubricant was diagnosed by bronchoalveolar lavage (BAL). BAL fluid separated into oily upper phase and lower aqueous phase spontaneously. Microscopic analysis of BAL cells revealed the presence of lipid-laden alveolar macrophages. Classic histochemical staining and electron microscope examination indicated that neutral lipid was dominant but phospholipid was also present in the lipid-laden macrophages. Together with the history of ingestion of liquid paraffin, we identified that the ingested liquid paraffin was the origin of the neutral lipid in the lipid-laden macrophages observed in the BAL fluid.

Organizing pneumonia adjacent to lung cancer: frequency and clinico-pathologic features

In order to assess the frequency of peripheral organizing pneumonia (OP) in patients with resected lung tumours and to describe its differential features, a cross-sectional study with prospective data collection was realized in a community teaching hospital. Demographic and clinical data were collected from clinical records. The lung specimens removed with a curative purpose in 89 consecutive patients with lung tumours were studied and the clinical and pathological characteristics of patients with and without OP were compared. In 33 of 89 patients (37%) included, OP in the vicinity of neoplasm was found. Areas of other types of fibrosis were evident in 21 patients (24%). Male gender, smoker, epidermoid histological type and the presence of lipid pneumonia were found with a significant higher frequency in patients with OP. Although without significant differences, the presence of symptoms and the bronchial stenosis were found more frequently in patients with OP. In conclusion, OP pattern adjacent to lung cancer, frequently associated to lipid pneumonia, is a common pathological finding. Male gender, a history of tobacco use and epidermoid histological type appear as risk factors for developing this pathologic pattern. Given the lack of distinctive clinico-pathological features, cancer adjacent OP could be confounded with other etiologic forms of this fibrotic process.

Successful treatment of endogenous lipoid pneumonia due to Niemann-Pick Type B disease with whole-lung lavage

In Type B Niemann-Pick disease, progressive pulmonary infiltration is a major cause of morbidity and mortality, although the disease is usually diagnosed before adulthood in other organ systems. To date, no successful treatment of pulmonary involvement by Niemann-Pick disease has been documented. We describe the case of a patient with Niemann-Pick Type B disease who presented with extensive endogenous lipoid pneumonia and life-threatening hypoxia following bypass grafting for severe coronary artery disease. A surgical lung biopsy at the time of grafting revealed characteristic histology and ultrastructural features of Niemann-Pick disease, with confirmatory findings in biochemical studies. Because of the severity of the patient's symptoms, bilateral whole-lung lavage was undertaken, leading to symptomatic improvement, lessening of parenchymal opacification on high-resolution computed tomographic scanning, and a marked improvement in resting arterial oxygen tension while breathing air to 10.3 kPa from 8.4 kPa. Whole-lung lavage may be a potentially useful modality of treatment for patients with pulmonary involvement by Niemann-Pick Type B disease.

[Diffuse infiltrative lung diseases due to allergy and iatrogenic causes]

Iatrogenic and hypersensitivity infiltrative pneumonias comprise 3 distinct entities: extrinsic allergic alveolitis, drug-induced pneumonia and radiation-induced pneumonia. The diagnosis of the latter is usually easy, except for the recently identified postradiation bronchiolitis obliterans organizing pneumonia. Diagnosis of extrinsic allergic alveolitis is based on the association of clinical, radiological, functional, immunological criteria and bronchoalveolar lavage fluid analysis. The polymorphous presentation of drug-induced pneumonia makes its diagnosis critical except for a few causes such as amiodarone pneumonia or lipoid pneumonia.

Exogenous lipid pneumonia related to smoking weed oil following cadaveric renal transplantation

A 30-year-old female presented shortly after cadaveric renal transplantation with respiratory distress typical of a bacterial infection. Following initial improvement, she developed progressive respiratory failure, initially felt to be secondary to cytomegalovirus infection. Two bronchoalveolar lavages were nondiagnostic, and an open lung biopsy was performed, which revealed a pulmonary alveolar proteinosis (PAP) reaction and exogenous lipid pneumonia (ELP). The ELP was considered to be secondary to the use of marijuana, in the form of weed oil, that was smoked daily for over 10 years and stopped just before renal transplantation. This is the first description of both PAP and ELP following renal transplantation, and the first description of ELP related to smoking weed oil. Physicians should be aware of the different forms of marijuana available and of their potential medical complications.

Ultrastructural changes in animal fat associated lipoid pneumonia: report of two cases

Traditional or cultural practices in different parts of the world where oils are used continue to produce lipoid pneumonia. We report the ultrastructural findings and observations in animal fat associated lipoid pneumonia from two children following a cultural practice of forced feeding with animal fat (ghee). Clinical findings showed an acute or chronic chest infection which failed to respond to anti-microbial therapy. X-ray and chest CT scan revealed collapse/consolidations of the right middle and left lower lobes. Histology and electron microscopy revealed thickening and destruction of the alveolar septa, filling of alveolar spaces with red blood cells and macrophage which contained both primary and secondary lysosomes. The alveolar walls contained mostly type II pneumocyte with most of them surrounded by thickened basement membranes with only a small portion of their surfaces exposed directly to the alveolar space where it showed numerous microvilli.

Aspiration diseases: findings, pitfalls, and differential diagnosis

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.

Lung resections in bronchiectasis due to lipoid pneumonia: a custom-design approach

OBJECTIVE

To see the effect of "custom-designed" surgical resection of some severely damaged parts of the lungs in children with bronchiectasis caused by forced feeding of children early in their lives with animal fat "ghee".

DESIGN

All children with bronchiectasis--post lipoid pneumonia--who failed to respond to medical treatment had surgical removal of most affected parts of their lungs.

SETTINGS

Asir Central Hospital Abha, a referral hospital in Asir region of Saudi Arabia and a Teaching Hospital for College of Medicine and Health Sciences, King Khalid University, Saudi Arabia.

SUBJECTS

Six children aged between seven and 12 years with lipoid bronchiectasis were referred to paediatric surgical service for surgical treatment.

RESULTS

There was no surgical mortality. Apart from mild cough, all the pre-operative symptoms of the children disappeared. Two children died more than six months post-operatively due to the extent of the original disease.

CONCLUSION

Surgical resection designed to remove the most affected parts of the lungs in diffuse-type bronchiectasis is recommended when there is failure of medical treatment.

Alveolar cells in cyclophosphamide-induced lung injury. II. Pathogenesis of experimental endogenous lipid pneumonia

An ultrastructural and histological study was made to analyse the structural and cellular features of the pulmonary lesions produced in Wistar rats by intraperitoneal (i.p.) administration of cyclophosphamide (two i.p. doses of 150 mg CP/1 kg bw/1 ml PBS). Rats exposed to cyclophosphamide (CP) developed a condition whose morphological picture corresponded to endogenous lipid pneumonia and/or pulmonary alveolar proteinosis-like changes. Damage to the endothelium and neutrophil accumulation in lung vascular bed were found to be potential initiators of endogenous lipid pneumonia-type changes. The possibility of the evolution of the acute lung injury into endogenous lipid pneumonia-type changes and into alveolar proteinosis-like changes was demonstrated. The results of the study supplement the existing theories of pulmonary alveolar proteinosis pathogenesis.

Lipoid pneumonia: a silent complication of mineral oil aspiration

INTRODUCTION

Chronic constipation is a common symptom in pediatrics, and physicians often use mineral oil to treat chronic constipation in children. Mineral oil, a hydrocarbon, may not elicit a normal protective cough reflex and may impair mucociliary transport. These effects can increase the likelihood of its aspiration and subsequent impaired clearance from the respiratory tract. We report a case of a child with neurodevelopmental delay with chronic constipation and a history of chronic mineral oil ingestion presenting as asymptomatic exogenous lipoid pneumonia (ELP).

CASE HISTORY

A 6-year-old white boy with a history of developmental delay was found to have an infiltrate in his right upper lobe on a chest radiograph obtained during evaluation for thoracic scoliosis. The patient had a long history of constipation with daily use of mineral oil. He was fed by mouth and had occasional episodes of coughing and choking during feeding. He was asymptomatic at presentation and physical examination was unremarkable. The patient was advised to stop administration of the mineral oil and was treated empirically with antibiotics during a 3-month period. At follow-up examination the patient continued to be asymptomatic, with the radiologic persistence of the infiltrate. Diagnosis of lipoid pneumonia was made by diagnostic bronchoscopy with bronchoalveolar lavage (BAL). The exogenous origin of the lipid in the BAL fluid was confirmed by gas chromatography/mass spectrometry.

DISCUSSION

The clinical presentation of ELP is nonspecific and ranges from the totally asymptomatic patient with incidental radiologic finding, like our patient, to the patient with acute or chronic symptoms attributable to pneumonia, pulmonary fibrosis, or cor pulmonale. Bronchoscopy with BAL can be successful in establishing the diagnosis of ELP by demonstration of a high lipid-laden macrophage index. Treatment of ELP in children is generally supportive, with the symptoms and roentgenographic abnormalities resolving within months after stopping the use of mineral oil.

CONCLUSION

Lipoid pneumonia as a result of mineral oil aspiration still occurs in the pediatric population. It can mimic other diseases because of its nonspecific clinical presentation and radiographic signs. In patients with swallowing dysfunction and pneumonia, a history of mineral oil use should be obtained and a diagnosis of ELP should be considered in the differential diagnoses if mineral oil use has occurred. Our case points to the need for increased awareness by the general pediatricians of the potential hazards of mineral oil use for chronic constipation.

Lipoid pneumonia in lung cancer: radiographic and pathological features

BACKGROUND

Obstructive pneumonia, a synonym for endogenous lipoid pneumonia, is often seen in patients with lung cancer, but details of this condition are still uncertain.

METHODS

To elucidate the features of obstructive pneumonia, we radiopathologically studied 147 patients with lung cancer that had been resected.

RESULTS

Gross inspection of the resected materials revealed evidence of endogenous lipoid pneumonia in 33 of the 147 patients with radiography that corresponded to obstructive pneumonia. We classified the 33 cases into three types as follows: (1) type I lipoid pneumonia, localized to the lung parenchyma distal to an airway obstructed by a tumor (23 cases); (2) type II lipoid pneumonia, features of type I lipoid pneumonia and consecutively spreading to the adjacent segment whose airway was not affected (five cases); (3) type III lipoid pneumonia, features of type II lipoid pneumonia and spreading to the isolated segments (five cases). Lipoid pneumonia was found in 16 of 89 (18%) adenocarcinoma cases and in 17 of 55 (31%) squamous cell carcinoma cases. In type I lipoid pneumonia, squamous cell carcinoma cases were predominant over adenocarcinoma cases (14 vs nine cases), but in type III lipoid pneumonia, adenocarcinoma cases predominated (four vs one case). Further, in cases of type III lipoid pneumonia, radiographs frequently revealed that lung cancers were cavitated.

CONCLUSION

Lipoid pneumonia in lung cancer may be associated with factors that play a larger role than the cancer alone. It can be speculated that transbronchial dissemination of breakdown products of adenocarcinoma cells, including mucin, may contribute to the spread of the non-obstructive component of lipoid pneumonia, because the local physical effect of obstructed bronchus does not affect the non-obstructive component.

Mineral oil lipoid pneumonia in a child with anoxic encephalopathy: treatment by whole lung lavage

We describe a case of exogenous lipoid pneumonia in a child with anoxic encephalopathy who was taking mineral oil for constipation. Computed tomography produced images suggesting this condition, and the diagnosis was confirmed by demonstrating the presence of lipid-laden alveolar macrophages in the bronchoalveolar lavage fluid. Despite discontinuing the offending agent, the pulmonary infiltrates did not improve; however, successful resolution was obtained by whole lung lavage.

Diffuse progressive pulmonary interstitial and intra-alveolar cholesterol granulomas in childhood

We describe an 18 year old male with pulmonary interstitial and intra-alveolar cholesterol granulomas (PICG), which developed to severe respiratory failure over 15 yrs. The histological diagnosis was made on the basis of open lung biopsy findings at the age of 3 yrs and autopsy at 18 yrs of age. Although the pathological features of the lung were similar to that of paediatric patients with lipoid pneumonia coexisting with pulmonary alveolar proteinosis (PAP), gastro-oesophageal reflux (GOR) and a diverse group of severe primary diseases, the patient lacked evidence for any of these. We believe the present case provides a new example of a diffuse-type of lipoid pneumonia coexisting with pulmonary alveolar proteinosis, which we call cholesterol granulomas.

Lipoid pneumonia: a case of cavitary bilateral nodular opacity

Lipoid pneumonia is a rare disease resulting from the inhalation of fatty or oily materials into the lungs. It can look like acute or chronic pneumonia or a localized granuloma (called paraffinoma). The clinical and radiological features are usually nonspecific and can suggest lung cancer or tuberculosis. As in most cases accidental inhalation of fatty material escapes anamnestic investigation, lipoid pneumonia is rarely diagnosed without invasive intervention. The present study refers to a case of cavitary bilateral nodular opacity due to the accidental inhalation of paraffin oil used as a laxative, whose radiological appearance was quite similar to Wegener's granulomatosis.