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Weekly Chest CasesCases by Disease Category

Case No : 1273 Date 2022-03-14

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  • Courtesy of Suji Lee, Young Joo Suh / Severance hospital
  • Age/Sex 71 / M
  • Chief ComplaintFever, sputum PHx: HTN, Allergic rhinigis, Squalene taking history.
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Lipoid pneumonia (exogenous)
Radiologic Findings
Fig 1. Chest PA shows GGO and consolidation in both lower lung fields.
Fig 2-5. CT scans reveals multifocal GGO and consolidation with interstitial thickening and some crazy-paving pattern areas in both lungs, mainly at dependent portions.
Brief Review
Lipoid pneumonia can be either exogenous or endogenous in cause based on the source of the lipid. Exogenous lipoid pneumonia usually occurs when animal fats or mineral or vegetable oils are aspirated or inhaled, whereas endogenous lipoid pneumonia results from lipid accumulation within intra-alveolar macrophages in the setting of bronchial obstruction, chronic pulmonary infection, pulmonary alveolar proteinosis, or fat storage diseases.
Radiologic findings include the pulmonary opacities with ground-glass or consolidative, bilateral, and segmental or lobar in distribution and predominantly involve the middle and lower lobes. CT can reveal areas of fat attenuation as low as -30HU within the consolidative opacities and nodules, a finding diagnostic of lipoid pneumonia. However, even though the attenuation of the opacities or nodules can be low at initial presentation, the presence of superimposed inflammation can be a confounding factor by increasing the attenuation so that the fat component becomes less conspicuous or obscured. In the chronic phase, architectural distortion and interlobular septal thickening with fibrosis could be accompanied due to the transposition of oils from the alveoli in the lung interstitium. Additionally, ground-glass opacities with associated interlobular septal thickening (crazy-paving pattern) with a basilar predominance have also been described.
The information of various ways that a patient can be exposed to lipid-containing material is essential in the diagnosis of exogenous lipoid pneumonia.
Please refer to
Case 1261, Case 1069, Case 747, Case 639, Case 554, Case 134, Case 24,
References
1. Betancourt SL, Martinez-Jimenez S, Rossi SE, Truong MT, Carrillo J, Erasmus JJ. Lipoid pneumonia: spectrum of clinical and radiologic manifestations. American Journal of Roentgenology. 2010;194(1):103-9.
Please refer to
Keywords
lipoid pneumonia,

No. of Applicants : 128

▶ Correct Answer : 116/128,  90.6%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - , Korea (South) JOHN BAEK
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - , Japan JUN KANZAWA
  • - , China XUFGENG ZHENG
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - No.2 Hospital ZiGong , China ZHOU XIA
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - , France ANNE-LAURE LEJEUNE
  • - Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
  • - , United Kingdom SAMSON KADE
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - CHCB , France LE GUEN RAPHAEL
  • - Osaka Red Cross Hospital , Japan YUSUKE UTSUNOMIYA
  • - NIMS, HYDERABAD , India BHASKAR K
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - , Japan CHIAKI SATO
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - Chonnam National University Hwasun Hospital , Korea (South) HONG SEOK CHOI
  • - , Korea (South) YOON JI HWANG
  • - Other , Korea (South) HWANGHEE JO
  • - Asan Medical Center , Korea (South) EUNJI CHOI
  • - Chungbuk National University Hospital , Korea (South) JIYUN KANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Ajou University Hospital , Korea (South) KYUNGMIN LEE
  • - Other , Korea (South) SEONGSU KANG
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - Manipal HealthMap , India SHASHANK SOOD
  • - Other , Korea (South) EUN HO JANG
  • - , Korea (South) JIN YOUNG LEE
  • - , China FANG YING GEN
  • - Chonbuk National University Hospital , Korea (South) YONG HWAN JO
  • - Chonbuk National University Hospital , Korea (South) DAEUL LEE
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Korea University Ansan Hospital , Korea (South) HYO YOUNG KIM
  • - Osaka University , Japan AKINORI HATA
  • - Kaneda hospital , Japan HIROFUMI MIFUNE
  • - Wonkwang University Hospital , Korea (South) HYOJOO KIM
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - , Korea (South) MINJI KIM
  • - , Korea (South) SUNHYANG LEE
  • - , Korea (South) HYEWON CHOI
  • - Japanese Red Cross Medical Center , Japan YASUSHI AOYAGI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Ajou University Hospital , Korea (South) MINJI KIM
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - , Korea (South) JAYOUNG MOON
  • - Kyeongpook National University Hospital , Korea (South) HYEONJUN JANG
  • - Other , Korea (South) JOO HEE KIM
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Dong-a University Medical Center , Korea (South) HYUN JIN KIM
  • - Chonbuk National University Hospital , Korea (South) HYUNSOO BAE
  • - Chonnam National University Hwasun Hospital , Korea (South) MYUNG WON SONG
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - , Korea (South) CHAEHUN LIM
  • - , Korea (South) YEONG UK HWANG
  • - Other , Korea (South) SEUNGHYUN LIM
  • - Other , Korea (South) MARI A
  • - , France LOIC BOISLIVEAU
  • - , United States HIROAKI TAKAHASHI
  • - , Brazil MARCELO B G FUNARI
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - , Albania AN G
  • - Centre Hospitalier Regional de Lanaudiere , Canada MATTHIEU STORME
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - none , Mongolia MUNKHGEREL DAVAA
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - , Qatar NABIL SHERIF MAHMOOD
  • - Chungbuk National University Hospital , Korea (South) CHANSEOP KIM
  • - Osaka city university Hospital , Japan TATSUSHI OURA
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Chungbuk National University Hospital , Korea (South) PARK JUN HYEON
  • - Manipal hospital Hebbal ,Bengaluru , India PRAVIN KUMAR M
  • - Osmania Medical College, Hyderabad , India PURUSHOTHAMA RAO TUMMALA
  • - Asan Medical Center , Korea (South) BYUNGSOO IM
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Hospital of Aosta , Italy ROBERTO CASTELLANA
  • - Other , Korea (South) KYU-CHONG LEE
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Samsung Medical Center , Korea (South) SUHO KIM
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Yonsei University,Severance Hospital , Korea (South) SUJI LEE
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Hanyang University Hospital , Korea (South) SUNJIN RYU
  • - Other , Korea (South) SUNYOUNG PARK
  • - Chonbuk National University Hospital , Korea (South) DONG HAN SHIN
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - TAKANA HAYASHI
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - , Japan KAZUMA TERAUCHI
  • - suzhou , China DR. WANG
  • - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
  • - Sotiria Hospital, Athens , Greece VASILIOS TZILAS
  • - , Japan YUMI MAEHARA
  • - College of Medicine, CHA University , Korea (South) PARK JONG WON
  • - , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - Chonbuk National University Hospital , Korea (South) HYEONG RYUN CHO
  • - , Korea (South) WONJU HONG
  • - , Korea (South) HM PARK
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - , China YU YAO
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 3/128,  2.3%
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - , Korea (South) SUBIN LEE
▶ Semi-Correct Answer : 3/128,  2.3%
  • - McGill , Canada MUTAZ ADNAN KHAIRO
  • - AIMS , India NITHYA HARIDAS MALIYAM
  • - Duncan Hospital, Raxaul , India SHYJUMON GEORGE
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Current Editor : Sang Young Oh, M.D., Ph.D Email : sangyoung.oh@gmail.com

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