Keywords:
Lung, Thorax, CT, CT-High Resolution, Computer Applications-Detection, diagnosis, Drugs / Reactions, Education and training
Authors:
D. Cozzi1, M. Bartolucci1, F. Giannelli1, C. Moroni1, E. Cavigli2, A. Bindi2, A. M. Grosso1, V. Miele1; 1Florence/IT, 2Firenze/IT
DOI:
10.26044/ecr2019/C-0796
Results
ELP has been found in:
- 4 laryngectomized patients (use of lubricants for tracheostomy)
- 6 dysphagic patients (4 use of paraffin oil for constipation; 2 use of oily-nasal spray).
CT findings showed:
- in 8/10 lung consolidation with adipose density (attenuation values <-40 HU);
- in 10/10 multiple areas of ground glass opacity (GGO)
- in 6/10 smooth thickening of interlobular septa and GGO ("crazy paving" pattern)
- in 2/10 nodules > 2.5 cm with spiculated margins (tumor-like)
- in 5/10 reactive lymph nodes enlargement
Pulmonary alterations are localized in the lower lobes in 10/10 and in 4/10 also in the posterior segments of the upper ones (Fig.
4-5).
Lung biopsy was performed in 5/10 patients.
Our CT findings suggestive for ELP correlate with the most recent literature's one.
High resolution chest CT is the best imaging modality for estabilishing the disgnosis of lipoid pneumonia.
The most characteristic finding in ELP is the presence of consolidations with areas of fat attenuation (negative attenuation values,
between -30 HU and -150 HU) (Fig 6-11).
Differential diagnosis sholud be done between ELP and other conditions with hypodense nodule/consolidation a CT exam: hamartoma,
lipoma,
necrotizing pneumonia,
mucinous adenocarcinoma,
post-obstructive pneumonia and pulmonary infarction (Fig.
12).
Moreover,
Marchiori et al.
demonstrated that also the "crazy paving" pattern was a common sign in adult patients with ELP.
In fact lipoid pneumonia is one of the differential diagnosis of acute/chronic "crazy paving" pattern,
toghether with pulmonary hemorrhage/edema,
acute or chronic eosinophilic pneumonia,
alveolar proteinosis,
infections (PJP,
CMV),
organizing pneumonia and hypersensitivity pneumonia (Fig.
13).