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Weekly Chest CasesCases by Disease Category

Case No : 1304 Date 2022-10-17

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  • Courtesy of Seulgi You, Joo Sun Sun, Kyung Joo Park / Ajou University School of medicine
  • Age/Sex 45 / F
  • Chief ComplaintDyspnea on exertion, cough
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Exogenous lipoid pneumonia
Radiologic Findings
Fig 1. Chest PA shows multifocal patchy consolidation and ground glass opacities in both lungs.
Fig 2-3. Chest CT scans reveals multifocal consolidation and ground glass opacities in both lungs. Some regions show crazy paving appearance represented as ground glass opacities and superimposed interlobular septal thickening. Enlarged LNs were noted in subcarinal and Rt interlobar area.
Fig 4. Six years ago, the patients underwent chest CT scan. There was focal consolidation with internal air bronchogram in LLL.
Brief Review
Exogenous lipoid pneumonia was confirmed via wedge resection. The patient has taken squalene for several years.
Lipoid pneumonia is an uncommon disease that results from accumulation of lipids in the alveoli and can be either exogenous or endogenous. 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. Symptoms include cough, mild fever, shortness of breath and chest comfort. Chest radiographs are usually nonspecific with bilateral lower lobe air space opacities, mixed alveolar and interstitial opacities. Occasionally, focal mass-like lesions could be shown. Lipoid pneumonia manifest as multifocal geographic GGO and consolidation with a predilection for dependent lungs on chest CT. Chest CT characteristically show low attenuation (-35 to -75 HU) indicating the presence of lipid deposition within consolidative areas. However, because inflammation or fibrosis may accompany the presence of the lipid material, the CT attenuation of the consolidation need not to be low. A crazy-paving pattern may also be seen and the crazy-paving pattern reflects intraalveolar and interstitial accumulation of lipid-laden macrophages and hyperplasia of type II pneumocytes in the alveolar lining. Since PET-CT shows increased uptake of 18F-FDG due to inflammatory component, it could be misinterpreted as malignancy.
Diagnosis can be difficult, since many patients do not recall a history of ingestion or inhalation of mineral oil substances. Bronchoalveolar lavage, transbronchial biopsy, or open lung biopsy combined with a history of oil ingestion and radiographic studies are usually diagnostic. The mainstay of management in exogenous lipoid pneumonia is control and cessation of offending agent.
References
1. BETANCOURT, Sonia L., et al. Lipoid pneumonia: spectrum of clinical and radiologic manifestations. American Journal of Roentgenology, 2010, 194.1: 103-109.
Keywords

No. of Applicants : 81

▶ Correct Answer : 18/81,  22.2%
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - , Japan KYOKO NAGAI
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Hpital du Sacr Coeur , Canada Andrea Ojanguren
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - , Italy PAOLO BALDASSARI
  • - Other , Korea (South) SEONGSU KANG
  • - , Korea (South) HYEWON CHOI
  • - Yamanashi Prefectural Central Hospital , Japan HIROAKI WATANABE
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - Mallinckrodt Institute of Radiology , United States NAGANATHAN MANI
  • - , Japan SHUNJIRO NOGUCHI
  • - Centre Hospitalier Regional de Lanaudiere , Canada MATTHIEU STORME
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Manipal hospital Hebbal ,Bengaluru , India PRAVIN KUMAR M
  • - Paras hospital, Panchkula , India SHALEEN RANA
▶ Correct Answer as Differential Diagnosis : 11/81,  13.6%
  • - Kyoto University Hospital , Japan YUSUKE UTSUNOMIYA
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Osaka University , Japan AKINORI HATA
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
▶ Semi-Correct Answer : 4/81,  4.9%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - CHCB , France LE GUEN RAPHAEL
  • - , Turkey MURAT TEPE
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
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