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Hematoxylin- and eosin-stained slide (ÿ200) of patient's lung tissue. Instead of normal alveoli in the lung, there are empty spaces of different sizes, lined with partially flattened multinucleated giant cells. Between those empty places, there is fibrous connective tissue, sometimes with infiltration of lymphocytes. In the connective tissue, there are also foreign body granulomas with large multinucleated cells that have vacuoles in the cytoplasm. The lesions do not have a distinct margin from the normal lung.
Source publication
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.
We report a case of a 38-year-old woman with bilateral pulmonary infiltration. There were no clinical symptoms of this infiltration at diagnosis. Th...
Context in source publication
Context 1
... (lymphocytes 21%). The transthoracic lung biopsy revealed vacuolated macrophages, giant cells, optically empty spots, a foreign body reaction with granulomatous process. All vacuolated macrophages contained lipids (lipophages) and represented 35% of all cells in the biopsy. This finding raised the suspicion of oil sub- stance aspiration ---ELP (Fig. 3). Subsequently, the patient confessed to daily nasal application of baby body oil drops (with azulene and medicinal liquid paraffin) over a period of five years to treat the dryness of her nasal mucosa. The otorhinolaryngologic examination was normal. The patient refused glucocorticoid therapy. Regular controls of the pul- monary ...Similar publications
Chronic obstructive pulmonary disease (COPD) is a heterogeneous disorder, and various aspects of COPD may be associated with the severity of pneumonia in such patients.
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Background:
Chest computed tomography (CTC) has now replaced chest X-ray (CXR) as the first choice of investigation to stage breast cancers in most centers in Australia. Routine staging is not recommended in early breast cancers (EBCs). This recommendation is based largely on the use of conventional tests like CXR as staging investigations (SIs)....
Citations
... 4 Ciertas alteraciones anatómicas y funcionales faríngeas o esofágicas que causen trastornos de la deglución pueden incrementar el riesgo de aparición, tales como, divertículo de Zenker, fístula traqueoesofágica, hernia hiatal, reflujo gastroesofágico, acalasia, enfermedades neuromusculares que afecten la motilidad faríngea o el reflejo de la tos. 5 En sujetos normales, la aspiración guarda relación con su ocupación o hábitos, tales como uso de laxantes aceitosos, bálsamos y brillos labiales, gotas nasales, alimentos con base en grasas animales, administración nasal de mentoles, grandes cantidades de productos a base de petróleo, lubricantes y limpiadores de maquinaria, pulverización de pesticidas o pinturas, consumo de grasa negra de tabaco, fármacos como amiodarona, actividades como traga fuego. 6 Otros factores desencadenantes suelen estar asociados a factores iatrogénicos como inserción de tubos nasogástricos con sustancias lubricantes. ...
Resumen Introducción: la neumonía lipoidea exógena es una enfermedad pulmonar inflamatoria poco común, desencadenada por la inhalación o aspiración de material graso de origen animal, vegetal o mineral. El diagnóstico se establece a través de confirmación histo-patológica, por la presencia de macrófagos cargados de lípidos en muestras respirato-rias, asociado a las características clínicas específicas al momento de su presentación. Requiere de un alto nivel de sospecha y una adecuada anamnesis de los antecedentes exposicionales del paciente debido a que muchos casos son subdiagnosticados y trat-ados como neumonía adquirida en la comunidad, lo que retrasa su diagnóstico y mane-jo, sumado a la ausencia de guías disponibles para su tratamiento. Se han reportado pocos casos de sobreinfección por tuberculosis en pacientes con neu-monía lipoidea exógena crónica. Caso clínico: femenino 33 años, con antecedentes de exposición crónica a sustancias desinfectantes de características aceitosas sin protección de vía aérea, con cuadro de tos y dolor torácico. Conclusión: el diagnóstico temprano, asociado a tratamiento de soporte, general-mente conservador, favorece la mejoría clínica y radiológica, y de esta manera dis-minuye la morbimortalidad. Abstract Introduction: exogenous lipoid pneumonia is a rare inflammatory lung disease, trigge
... Exogenous lipoid pneumonia is a rare High-resolution computed tomography is the most desirable radiography modality to diagnose lipoid pneumonia 9 Corticosteroids are not recommended to be given in cases where fibrosis is the main or only feature on radiology examination. 8 Antibiotics administration are usually given in severe cases because its frequently complicate with bacterial infection, or in any other condition where a bacterial pneumonia is also suspected. ...
Background : Lipoid pneumonia is a rare disease and usually reported as sporadic cases. Exogenous lipoid pneumonia is a more common form of lipoid pneumonia. Untypical characteristics makes incidence rate of this cases are often imprecise. The diagnosis is made from a history of lipid containing material aspiration, radiologic imaging, and histopathological examination. There is no treatment of choice because diagnosis of this cases are rarely made. Case Report : We report one case at Dr. Saiful Anwar hospital, a 35 years old man with accidental kerosene ingestion and aspiration. Based on examination of the patient, laboratory results, radiological imaging, and BAL fluid analysis and cytology, diagnosis of exogenous lipoid pneumonia was made. Our treatment of choice was combination of antibiotic, corticosteroid and BAL to manage this patient. After 2 weeks of treatment, there were improvements on clinical and radiological imaging. Conclusion: Exogenous lipoid pneumonia is a rare disease. Using antibiotic, corticosteroid, and BAL through bronchoscopy can be a therapeutic option that provides clinical and radiological improvement. Key words : Lipoid Pneumonia, Exogenous Lipoid Pneumonia, Treatment of Lipoid Pneumonia
... To date, no standard treatment regimen has been established. Antibiotic treatment for severe cases seems justified, considering bacterial superinfection [7][8][9][10][11][12][13]. Several case reports demonstrated the effectiveness of therapeutic lung lavage for lipoid Fig. 2. A Chest CT showed necrotic consolidations with air bronchograms in right middle lobe (lung window). ...
Background
Exogenous lipoid pneumonia is a rare entity, the diagnosis is often missed or delayed.
Objective
To investigate the clinical characteristics of exogenous lipid pneumonia in elderly patients, improve the efficiency of early diagnosis and treatment of this disease.
Methods
Retrospectively analyzed the clinical information and imaging data of these 2 exogenous lipid pneumonia patients, reviewed related literature.
Results
Both of the 2 patients were over 60 with a history of gastrointestinal diseases. The clinical presentation is nonspecific. Chest CT showed many different manifestations. Histopathology analysis revealed the accumulation of lipid carrying macrophages, vacuolar cells and inflammation. A literature review indicated that 25 previous cases of exogenous lipid pneumonia were caused by aspiration. The most common site of the lesion was located in right lung, while mineral oil was the most common substances. We sought to discuss the patient's treatment and the corresponding outcomes.
Conclusion
The diagnosis of lipid pneumonia's mainly depends on medical history and histopathological morphology. The standard treatment for exogenous lipid pneumonia was composed of antibiotics, steroid, bronchoscopic lavage and a regular follow-up.
... However, there are few studies in which ELP masses are followed and measured after patients have stopped using oil-based substances. In one case involving a 38 year old woman with ELP, the mass was reported to have diminished 2 years after stopping oil ingestion, but the decrease was not quantified [22]. In the present case we measured the ELP mass at the time of diagnosis and 26 months after the patient discontinued use of mentholated petroleum ointment, and found a 10 % decrease in size. ...
Background
Use of petroleum-based over the counter remedies such as Vicks VapoRub to alleviate symptoms of rhinitis is common and can be effective, but carries under-appreciated risks of adverse side effects. In this case report we highlight Exogenous Lipoid Pneumonia (ELP), an uncommon condition that results from accumulation of exogenous lipids in the alveoli, as an adverse side effect of long-term Vicks VapoRub use. Case presentationWe present the case of an 85-year-old female patient with ELP apparently due to continuous application of Vicks VapoRub® to her nostrils to alleviate chronic rhinitis. She was diagnosed incidentally via chest radiograph and computed tomography (CT) scan done as follow up to finding elevated C-reactive Protein during a routine exam. The CT scan revealed a pulmonary consolidation in the lower lobe of the right lung with fat density combined with low density areas associated with focal ground-glass opacities. The patient was advised to discontinue use of petroleum-based products, and was prescribed intranasal corticosteroids for her rhinitis. Follow up 2 years later showed that the lipid consolidation had diminished in size by approximately 10 %. Conclusion
Physicians must be aware that ELP can develop as a result of long-term application of petroleum-based oils and ointments to the nose and discourage such use of these products. Patients who have used petroleum-based products in this way should be screened for ELP. CT scan is the best imaging modality for establishing the diagnosis. The treatment of this condition is not well defined, but, as shown in this case, the size of the lipid mass can decrease after use of petroleum based substances is discontinued.
... (M. Doubková, 2013). ...
... Este tipo es menos frecuente y resulta de la acumulación de lípidos endógenos derivados del pulmón, cuando los lípidos que normalmente se encuentran en el tejido pulmonar son liberados consecuencia de la ruptura de las paredes alveolares, cuando hay obstrucción bronquial por tumores o bronquiolitis obliterante por ejemplo, o puede ser manifestación de infecciones o patologías no asociadas obstrucción como enfermedades del tejido conectivo o enfermedades por alteraciones del almacenamiento de lípidos como la enfermedad de Gaucher o Niemann-Pick (M. Doubková, 2013). Por lo tanto su fisiología se puede explicar por muchos mecanismos dependiendo de cuál sea la causa, por ejemplo: secreciones epiteliales retenidas, hipoxia prolongada o acumulación de productos de células cancerosas como adenocarcionomas (G.C. ...
... (Edson Marchiori, 2011) (M. Doubková, 2013) El tratamiento en ambos casos no ha sido bien estudiado, únicamente se has reportado algunos casos. ...
La neumonía lipoidea es una condición poco común que resulta de la presencia de lípidos en el interior del espacio alveolar. Según la fuente de los lípidos se ha clasificado en endógena y exógena y esta a su vez según la presentación en aguda y crónica. La neumonía lipoidea exógena se produce por aspiración o inhalación de sustancias oleosas, suele presentarse en pacientes con predisposición a broncoaspiración por alteraciones anatómicas o neurológicas, sin embargo se puede presentar en pacientes sanos que están expuestos a este tipo de sustancias y suele ser en el medio laboral. La fisiopatología es secundaria a una respuesta de cuerpo extraño que termina en fibrosis pulmonar. Los síntomas que produce al igual que manifestaciones al examen físico son inespecíficos y los hallazgos en los exámenes de laboratorio y gabinete también lo son, esto hace que sea una patología poco diagnosticada; sin embargo, haciendo una buena historia clínica e historia laboral se puede sospechar su diagnóstico en el caso de los médicos tratantes o establecer una relación de causalidad en el caso del médico forense. Presentación de caso: Se expone el caso de masculino de 34 años de edad referido por un caso de riesgo laboral, el mismo sin antecedentes patológicos conocidos, quien estuvo expuesto al humo del vehículo que conducía, posteriormente inicia con síntomas respiratorios inespecíficos y finalmente es diagnosticado con neumonía lipoidea.
Objectives
To report 2 cases of lipoid pneumonia.
Summary
Lipoid pneumonia is an inflammatory process in the lower airways due to the presence of lipid molecules in the alveoli. Exogenous lipoid pneumonia is due to the inhalation or aspiration of fat-containing substances. Historically, mineral oil is the most common medication cause but there have also been several reports of lipoid pneumonia associated with petroleum jelly, medicated vapor rub, and lip glosses. Two case reports are presented to illustrate the importance of identifying risk factors for lipoid pneumonia.
Results
Use of the Naranjo algorithm suggested that both cases of lipoid pneumonia were “possibly” due to aspiration of lipid-containing over-the-counter agents. The first case was associated with aspiration of mentholated topical ointment applied intranasally, whereas the second case was attributed to probable aspiration of mineral oil for management of chronic constipation.
Conclusion
Pharmacists in many practice settings can play an integral role in preventing this condition and screening for patients who may warrant a diagnostic workup. During medication reconciliation, pharmacists should identify all prescription and nonprescription medications used by patients. Patients should specifically be asked about lipid-based over-the-counter products and cosmetic agents.
Postmortem investigation often reveals various conditions, which may or may not have played a part in the death of the individual. The case of a 32-year-old woman is reported, with a long history of drug addiction. She was found dead in her bed. The autopsy revealed diffuse pulmonary edema with congestion of the lungs, brain, liver, and spleen. Microscopic examination of the lungs showed multiple intra-alveolar and interstitial foamy macrophages and extracellular fat droplets surrounded by polynuclear giant cells. Death was attributed to acute polydrug intoxication. As microscopic examination had revealed severe pulmonary lesions, lipoid pneumonia was considered as a contributing factor to death. Lipoid pneumonia is an uncommon entity with the characteristic radiograph features and histologic findings of alveoli filled with vacuolated, lipid-laden histiocytes. It can be either exogenous or endogenous in cause, based on the source of the lipid. Exogenous lipoid pneumonia usually results from aspiration or inhalation of fat-like material, such as mineral oil or petroleum-based lubricants and decongestants, resulting in pulmonary inflammatory reactions.
