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Weekly Chest CasesArchive of Old Cases

Case No : 554 Date 2008-06-09

  • Courtesy of Jeung Sook Kim, MD. / Dongguk University International Hospital, Korea.
  • Age/Sex 76 / M
  • Chief ComplaintCough / white sputum onse: 4month ago
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Exogenous lipoid pneumonia
Radiologic Findings
Chest PA radiograph shows ill-defiined opacities and curvilinear density in right lower lung zone. HRCT scans show patchy area of ground-glass opacity (GGO) and reticular densities in right middle lobe and both lower lobes. The area of poorly defined small nodules and branching linear densities are also noted in both right lower lobes.

He has a history of repeated ingestion of shark liver oil (squalene) for two years. He ingested the squalene without peel by needle puncture at peel and squeezing.
Brief Review
Exogenous lipoid pneumonia is an uncommon condition resulting from aspiration or inhalation of mineral, vegetable, or animal oils (present in food, radiographic contrast media, or oil-based medications) into the lung. Predisposing factors such as neuromuscular disorders and esophageal abnormalities are frequently associated. Clinically, the patients present with a cough, shortness of breath, mild fever, and chest discomfort. But, chronic aspiration of oil is often undetected during lifetime and aspiration of oil commonly occurs in elderly subjects who may take their oily nose drops or cathartics at bedtime.

Pathologic findings of exogenous lipoid pneumonia include intra-alveolar foamy lipid-laden macrophages associated with interstitial pneumonia. Sometimes fat is entrapped in the interstitium.

Acute aspiration results in an aspiration pneumonia. Chronic aspiration results in lipoid pneumonia with variable fibrosis and inflammation.

Chest radiographic findings are consolidation, ill-defined opacities, or reticulonodular pattern. A lower lobe distribution is typical but not always present. HRCT shows areas of consolidation of low attenuation, indicating the presence of lipid deposit. Other HRCT finding is ground-glass opacity (GGO) with interlobular septal thickening and intralobular interstitial thickening, so-called crazy-paving pattern, reflecting interstitial inflammation or fibrosis. Poorly defined centrilobular nodules and consolidation are also noted. Right middle lobe and both lower lobes are commonly involved. Complete recovery or partial clearance of these lesions can be seen after cessation of squalene ingestion.
References
1. 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
2. Franquet T, Gimenez A, Bordes R, et al. The crazy-paving pattern in exogenous lipoid pneumonia: CT-Pathologic correlation. AJR 1998;170:315-317
3. Laurent F, Philippe JC, Vergier B, et al. Exogenous lipoid pneumonia: HRCT, MR, and pathologic findings. Eur Radiol 1999;9:1190-1196
4. Baron SE, Haramati, LB, Rivera VT. Radiological and clinical findings in acute and chronic exogenous lipoid pneumonia. J Thorac Imaging 2003;18:217-224
Please refer to
Case 24
Keywords
Lung, Interstitium, Inhalation and aspiration disease, Aspiration,

No. of Applicants : 74

▶ Correct Answer : 18/74,  24.3%
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - CMC , Korea (South) An yi
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - Konkuk university hospital , Korea (South) Jeong Geun Yi
  • - Cheongshim international medical center , Korea (South) yang Hae Jum
  • - , Korea (South) Kwon Kim
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - Gachon University Gil Medical Center , Korea (South) Soo Jin Choi
  • - Osaka University , Japan Osamu Honda
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
  • - Shinchon Severance Hospital , Korea (South) Ho-Joon Lee
  • - IRSA La Rochelle France , France Denis Chabassie
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - ottawa , Canada nishard abdeen
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - radiology department ANNECY , France gilles GENIN
▶ Correct Answer as Differential Diagnosis : 7/74,  9.5%
  • - chp st martin , France Mariotte benoit
  • - Regional Imaging Ltd. - Riverina, NSW, Australia , Australia Rashid Hashmi
  • - Yonsei University college of medicine Severance hospital , Korea (South) Hua Sun Kim
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Jackson Memorial Hospital , United States Naganathan Mani
  • - All India Institute of Medical Sciences , India Ashish Gupta
▶ Semi-Correct Answer : 36/74,  48.6%
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - McGill University Health Centre , Canada Amr Ajlan
  • - mediciti hospitals , India paramjyothi gongati
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - CHRU lille , France manuel toledano
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - apollo hospitals , India harish bhambore
  • - partner, aditya imaging centre , India vivek patel
  • - All India Institute of Medical Sciences , India puneet kochar
  • - Marien Hospital, Hamm , Germany Davis Chiramel
  • - University of virginia , United States sucheta sharma
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - Depatment of Radiology, Yongsan Hospital, College of Medicine, Chung-Ang University , Korea (South) Jae Seung Seo
  • - kims,narkatpally , India k bhaskar
  • - Ruby Hall Clinic , India sudarshan rawat
  • - Soon chun hyang university hospital bucheon , Korea (South) Hyelin Kim
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Trakya University School of Medicine , Turkey Derya Demir
  • - hospital Sao Paulo , Brazil israel missrie
  • - Mackay Memorial Hospital, Taipei , Taiwan Chia-Fu Tsai
  • - Good Gangan Hospital , Korea (South) Kyung Jung
  • - E-DA Hospital / I-Shou University , Taiwan Yu-Feng Wei
  • - Hopital universitaire Lausanne , Switzerland abed kourhani
  • - National Taiwan University Hospital , Taiwan Chin-Chung Shu
  • - EKH-Berlin , Germany Michael Weber
  • - Homs National Hospital , Syria Rami Abou zalaf
  • - CH de la Ce Basque , France Paul ARDILOUZE
  • - IRSA LA ROCHELLE FRANCE , France jean-luc BIGOT
  • - Trakya Univercity School of Medicine , Turkey Armagan Sarac
  • - UVA , United States Rachita Khot
  • - Mackay Memorial Hospital , Taiwan Shen ShengYeh
  • - Central Queensland Medical Imaging , Australia Sandeep Joshi
  • - OSWAL CANCER HOSPITAL , India LOVKESH MITTAL
  • - Soonchunhyang University Cheonan Hospital , Korea (South) Park Sang Hyun
  • - All India Institute of medical sciences , India Justin Moses
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