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
Aims and objectives
Lipoid pneumonia is an uncommon condition caused by pulmonary accumulation of fat-like compounds of animal,
vegetable or mineal origin.
It is classified in "endogenous" and "exogenous": the endogenous ones is caused by the accumulation of lipic substances (cholesterol and its esther) in lung tissues or due to lipidic storages diseases.
Chronic Exogenous lipoid pneumonia (ELP) usually results from repeated episodes of aspiration/inhalation of animal fat or mineral/vegetable oils over an extended period.
Also an acute form exists,
secondary to accidental (or not) inhalation of large quantity of lipid matherial over a short period of time.
Examples of chronic ELP: longstanding use of petroleum jelly at bedtime (Vicks™,
Vaseline),
excessive use of lip balm,
vaseline inhalation during the placement of naso-gastric tubes,
professional exposure to paraffine or others oily materials.
Other factors: elder patients,
tracheostomized patients,
g.e.
reflux disease,
hiatal hernia,
neuromuscolar disorders and swallowing dysfunctions.
Clinical manifestations: aspecific. From asymptomatic to severe respiratory failure.
Diagnosis is usually difficult because a history of oil ingestion is often missed.
The exposure is often identified retrospectively when the diagnosis is made.
Radiological diagnosis could be tricky if the radiologist doesn't know the prevalent CT findings.
Bronchiolo-alveolar lavage (BAL) and lung biopsy,
the more aggressive approach,
confirm the ELP diagnosis: the typical histopathological findings are macrophages with intracellular lipid vacuoles.
The purpose of this study is to describe the CT findings of our ELP series,
confirmed with histopatological findings and clinical-anamnestic data.