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Weekly Chest CasesArchive of Old Cases

Case No : 1069 Date 2018-04-23

  • Courtesy of Soyeoun Lim, Woon-Jung Kwon / Ulsan University Hospital
  • Age/Sex 65 / F
  • Chief ComplaintCough for 3 days. Wheezing and dyspnea in a 20 pack-year smoker.
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initial

Diagnosis With Brief Discussion

Diagnosis
Exogenous lipoid pneumonia
Radiologic Findings
On initial chest radiograph and CT, diffuse, ill-defined ground-glass opacities were noted in bilateral lungs. Those findings are spontaneously resolved on follow up chest radiograph and CT after 4 months. However, after 3 months, ill-defined ground-glass opacity was reappeared in a similar distribution.
Brief Review
The patient took omega-3 (fish oil) capsule for years, which contains oil.
Lipoid pneumonia results from chronic aspiration or inhalation of animal, vegetable or fish oil or fat over period. It is uncommon entity and has been reported in 1.0 – 2.5 % of autopsy series.
Patients with chronic exogenous lipoid pneumonia are usually asymptomatic and are only identified because of an incidentally detected abnormality on radiologic imaging.
The radiologic manifestations of chronic exogenous lipoid pneumonia are ground-glass opacity or consolidation involving one or more segments, typically with a peri-bronchovascular distribution and predominant involvement of the dependent portion, mostly lower lobes. Architectural distortion, thickening of the interlobular septa or fibrosis of adjacent lung has been reported. Crazy-paving pattern with a basal predominance have also been described. These radiologic findings of chronic exogenous lipoid pneumonia can improve slowly, but typically remain stable after cease the exposure to oil or fat.
On the specimen of bronchoalveolar lavage, foamy macrophages were detected.
References
1. Sonia L. Betancourt, Santiago Martinez-Jimenez, Santiago E. Rossi, et al. Lipoid Pneumonia: Spectrum of Clinical and Radiologic Manifestations. AJR 2010;194:103-109.
2. Baron SE, Haramati, LB, Rivera VT. Radiological and clinical findings in acute and chronic exogenous lipoid pneumonia. J Thorac Imaging 2003;18:217-224
3. Lee JY, Lee KS, Kim TS, et al. Squalene-induced extrinsic lipoid pneumonia: serial radiologic findings in nine patients. J Comput Assist Tomogr 1999; 23:730-735
4. W. Richard Webb, Nestor L. Muller, David P. Naidich. High-Resolution CT of the Lung. P416-418
Keywords
Lung, Non-infectious inflammation, Inhalation and aspiration disease,

No. of Applicants : 119

▶ Correct Answer as Differential Diagnosis : 2/119,  1.7%
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - , China YIN LIU
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