ABSTRACT
Introducción: la neumonía lipoidea exógena es una enfermedad pulmonar inflamatoria poco común, desencadenada por la inhalación o aspiración de material graso de origen animal, vegetal o mineral. El diagnóstico se establece a través de confirmación histo-patológica, por la presencia de macrófagos cargados de lípidos en muestras respirato-rias, asociado a las características clínicas específicas al momento de su presentación.Requiere de un alto nivel de sospecha y una adecuada anamnesis de los antecedentes exposicionales del paciente debido a que muchos casos son subdiagnosticados y trat-ados como neumonía adquirida en la comunidad, lo que retrasa su diagnóstico y mane-jo, sumado a la ausencia de guías disponibles para su tratamiento.Se han reportado pocos casos de sobreinfección por tuberculosis en pacientes con neu-monía lipoidea exógena crónica. Caso clínico: femenino 33 años, con antecedentes de exposición crónica a sustancias desinfectantes de características aceitosas sin protección de vía aérea, con cuadro de tos y dolor torácico. Conclusión: el diagnóstico temprano, asociado a tratamiento de soporte, general-mente conservador, favorece la mejoría clínica y radiológica, y de esta manera dis-minuye la morbimortalidad. (AU)
Introduction: exogenous lipoid pneumonia is a rare inflammatory lung disease, trigge-red by inhalation or aspiration of fatty material of animal, vegetable or mineral origin. The diagnosis is established through histological confirmation by the presence of lipid-laden macrophages in respiratory samples, associated with the specific clinical charac-teristics at the time of presentation. It requires a high level of suspicion and an adequate anamnesis of the patient's expo-sure history, since many cases are underdiagnosed and treated as community-acquired pneumonia, what delays its diagnosis and management, added to the absence of avai-lable guidelines for its treatment. Few cases of tuberculosis superinfection have been reported in patients with exoge-nous lipoid pneumonia.Clinical case: 33-year-old female, with a history of chronic exposure to oily disinfectant substances without airway protection, with symptoms of cough and chest pain.Conclusion: early diagnosis, associated with supportive treatment, generally conser-vative, favors clinical and radiological improvement, thus reducing morbidity and mor-tality. (AU)
Subject(s)
Humans , Female , Adult , Pneumonia, Lipid/diagnosis , Superinfection/diagnosis , Mycobacterium tuberculosis , Biopsy , Bronchoscopy , Tomography , Chronic DiseaseABSTRACT
La neumonía lipoidea es una enfermedad respiratoria poco conocida que resulta de la acumulación de lípidos de origen endógeno o exógeno a nivel del alveolo pulmonar. Suele ser subdiagnosticada ya que la presentación clínica es inespecífica, por lo que suele confundirse con otras patologías broncopulmonares. Se presentó el caso de un paciente de 18 años antecedentes de aspiración accidental de combustible que seis horas después comenzó con fiebre, hemoptisis, tos y disnea. Se realizó radiografía de tórax donde se observó una neumonía en base derecha que unido al interrogatorio y a la realización de la broncoscopía confirmaron el diagnóstico de neumonía lipoidea. El paciente evolucionó favorablemente con el tratamiento(AU)
Lipoid pneumonia is a little known respiratory disease that results from the accumulation of lipids of endogenous or exogenous origin in the pulmonary alveolus. It is usually underdiagnosed since the clinical presentation is nonspecific, which is why it is often confused with other bronchopulmonary pathologies. We report the case of an 18-year-old patient with a history of accidental fuel aspiration, who ran fever six hours later, together with hemoptysis, cough, and dyspnea. Chest X-rays showed a right base pneumonia. The questioning and the performance of the bronchoscopy confirmed the diagnosis of lipoid pneumonia. The patient evolved favorably with the treatment(AU)
Subject(s)
Humans , Male , Adolescent , Pneumonia, Aspiration/drug therapy , Pneumonia, Lipid/diagnosis , Bronchoscopy/methods , Radiography, Thoracic/methodsABSTRACT
La neumonía lipoidea es una patología pulmonar poco conocida que resulta de la acumulación de lípidos de origen endógenos o exógenos a nivel alveolar pulmonar. Suele ser subdiagnosticada dada que la presentación clínica es inespecífica, por lo que suele confundirse con otras patologías broncopulmonares, muchas veces no llegándose al diagnóstico preciso de esta. Dentro de los datos anamnesticos el antecedente, ya sea de uso reciente o de larga data, de la ingesta y/o inhalación accidental o voluntaria de alguna sustancia que contenga algún componente lipídico en su base es primordial. Pacientes de edades extremas suelen ser los más afectados y en quienes debemos tener la sospecha diagnóstica. Su diagnóstico es complejo requiriendo historia clínica, imágenes que apoyen un compromiso pulmonar (de preferencia tomografía computada) e idealmente la detección intraalveolar de lípidos y macrófagos cargados de éstos en el lavado broncopulmonar. Actualmente, no existe consenso sobre el manejo específico de esta patología. Lo importante es identificar la causa y descontinuar su uso. En neumonía lipoidea de causa exógena se recomienda manejo de soporte según sea la presentación clínica del paciente.
Lipoid pneumonia (LN) is an unknown lung disease due to lipid accumulation, of endogenous or exogenous origin, at the pulmonary alveolar level. Often it is underdiagnosed because of its nonespecific presentation whose differential diagnosis are other bronchopulmonary diseases. Anamnestic data, either recent or long-standing use of the intake and / or accidental or deliberate inhalationof any substance containing a lipid component as its base is relevant information. Extreme age groups are the most affected, and in whom wemust suspect LN diagnosis. The diagnosis of LN is complex and requires a complete medical history, images that support lung involvement (preferably computed tomography), and ideally intraalveolar detection of lipid-ladenmacrophages in the bronchoalveolar lavage. Currently, there is no consensus on the specific management of this disease. It is important to identify the cause and discontinue its exposure. Whatever the varity of the clinical presentation, support magement is recommended to treat LN.
Subject(s)
Humans , Female , Infant , Pneumonia, Lipid/chemically induced , Pneumonia, Lipid/therapy , Petrolatum/adverse effects , Pneumonia, Lipid/diagnosisABSTRACT
OBJETIVO: Relatar os aspectos na tomografia computadorizada de alta resolução de diversas doenças que cursam com o padrão tomográfico de "pavimentação em mosaico". MATERIAIS E MÉTODOS: Foram estudados sete pacientes, com diagnósticos de proteinose alveolar, carcinoma bronquíolo-alveolar, pneumonia lipídica e pneumocistose, e é discutida a correlação dos aspectos tomográficos com os achados anatomopatológicos. RESULTADOS: Nos casos de pneumocistose, os espaços alveolares estavam cheios de material espumoso, no qual eram encontrados parasitas de permeio a surfactante, fibrina e restos celulares. Nos casos de carcinoma bronquíolo-alveolar, os septos estavam espessados por fibrose ou por linfangite associada, com células tumorais revestindo internamente as paredes alveolares, e produção de muco. No paciente com proteinose alveolar foram observados septos espessados por edema, com enchimento alveolar determinado por material lipoproteico. No paciente com aspiração de óleo mineral, os achados histopatológicos foram de espessamento dos septos alveolares determinado por proliferação celular, observando-se vacúolos de gordura no interior dos septos alveolares. CONCLUSÃO: O padrão de pavimentação em mosaico oferece um amplo diagnóstico diferencial, necessitando ser avaliado em conjunto com os dados clínicos.
OBJECTIVE: To describe high-resolution computed tomography findings in several diseases that run their course with the "crazy-paving" pattern. MATERIALS AND METHODS: The present study has evaluated seven patients with diagnoses of alveolar proteinosis, bronchioloalveolar carcinoma, lipoid pneumonia and pneumocystosis, correlating tomographic and pathological findings. RESULTS: In the cases of pneumocystosis, the alveolar spaces were filled with foamy material where parasitic organisms intermingled with surfactants, fibrin and cell debris were observed. In the cases of bronchioloalveolar carcinoma, the septa were thickened by associated fibrosis or lymphangitis, with the alveolar walls internally lined with tumor cells, and production of mucus. In the patient with alveolar proteinosis, the septa were thickened by edema, with alveolar filling determined by lipoprotein. In the patient with mineral oil aspiration, the histopathological findings included alveolar septa thickening caused by cell proliferation, with presence of fat vacuoles in alveolar septa. CONCLUSION: The crazy-paving pattern offers a wide range of differential diagnoses and must be evaluated in conjunction with clinical findings.
Subject(s)
Humans , Adult , Carcinoma, Bronchogenic , Lung Diseases , Lung Neoplasms , Pulmonary Alveolar Proteinosis , Pneumonia, Lipid/diagnosis , Pulmonary Alveolar Proteinosis/diagnosis , Diagnostic Imaging , Tomography, X-Ray ComputedABSTRACT
Lipoid pneumonia is a rare form of pneumonia caused by inhalation or aspiration of fat-containing substances like petroleum jelly, mineral oils, certain laxatives, etc. It usually presents as an insidious onset, chronic respiratory illness simulating interstitial lung diseases. Rarely, it may present as an acute respiratory illness, especially when the exposure to fatty substance(s) is massive. Radiological findings are diverse and can mimic many other diseases including carcinoma, acute or chronic pneumonia, ARDS, or a localized granuloma. Pathologically it is a chronic foreign body reaction characterized by lipid-laden macrophages. Diagnosis of this disease is often missed as it is usually not considered in the differential diagnoses of community-acquired pneumonia; it requires a high degree of suspicion. In suspected cases, diagnosis may be confirmed by demonstrating the presence of lipid-laden macrophages in sputum, bronchoalveolar lavage fluid, or fine needle aspiration cytology/biopsy from the lung lesion. Treatment of this illness is poorly defined and constitutes supportive therapy, repeated bronchoalveolar lavage, and corticosteroids.
Subject(s)
Foreign-Body Migration/diagnosis , Foreign-Body Migration/etiology , Foreign-Body Migration/pathology , Foreign-Body Migration/diagnostic imaging , Humans , Macrophages , Mineral Oil/adverse effects , Pneumonia, Lipid/chemically induced , Pneumonia, Lipid/diagnosis , Pneumonia, Lipid/pathology , Pneumonia, Lipid/diagnostic imaging , Prognosis , Respiratory Aspiration/complications , Respiratory Function Tests , Risk FactorsABSTRACT
OBJETIVO: Descrever os aspectos da evolução da pneumonia lipoide em crianças, com base em aspectos clínicos, radiológicos e de achados no lavado broncoalveolar, enfatizando a importância diagnóstica e terapêutica da lavagem broncoalveolar. MÉTODOS: Foram incluídas 28 crianças, com idade média de 20 meses (1-108 meses) e diagnóstico de pneumonia crônica refratária a antimicrobianos e/ou TB. A maioria apresentava um fator de risco para aspiração, e todas apresentavam história de ingestão de óleo mineral para o tratamento de constipação intestinal (23/28) ou de ascaridíase complicada (5/28). A avaliação clínica e tomográfica e análises do lavado broncoalveolar foram realizadas no início do tratamento e em até 24 meses. RESULTADOS: Os sintomas mais frequentes foram taquipneia e tosse. As principais alterações radiológicas foram consolidações (23/28), infiltrado peri-hilar (13/28) e hiperinsuflação (11/28). A TC de tórax mostrou consolidações com broncograma aéreo (24/28), diminuição de atenuação nas áreas de consolidação (16/28), opacidade em vidro fosco (3/28) e padrão em mosaico (1/28). O estudo do lavado broncoalveolar apresentava macrófagos espumosos corados por Sudan, confirmando o diagnóstico da pneumonia lipoide. Após tratamento com múltiplas lavagens broncoalveolares (média = 9,6), 20 crianças tornaram-se assintomáticas, havendo normalização tomográfica em 18. CONCLUSÕES: O diagnóstico de pneumonia lipoide deve ser considerado na pneumonia crônica ou TB refratárias ao tratamento, especialmente se houver história de ingestão de óleo mineral. A broncoscopia com múltiplas lavagens broncoalveolares mostrou-se eficiente para a depuração do óleo aspirado do parênquima pulmonar e a prevenção da fibrose, contribuindo para a redução da morbidade dessa doença, que ainda é pouco diagnosticada.
OBJECTIVE: To present aspects of the evolution of lipoid pneumonia in children, based on clinical, radiological and bronchoalveolar lavage fluid findings, emphasizing the importance of bronchoalveolar lavage for the diagnosis and treatment. METHODS: We included 28 children, with a mean age of 20 months (range, 1-108 months), diagnosed with chronic pneumonia refractory to antimicrobial therapy, with TB or with a combination of the two. Most of the children had at least one risk factor for aspiration, and all of them had a history of mineral oil ingestion for intestinal constipation (23/28) or complicated ascaridiasis (5/28). Clinical evaluations, tomographic evaluations and analyses of bronchoalveolar lavage fluid were carried out at the beginning of treatment and throughout a follow-up period of 24 months. RESULTS: Tachypnea and cough were the most common symptoms. The most common radiological alterations were areas of consolidation (23/28), perihilar infiltrates (13/28) and hyperinflation (11/28). Chest CT scans showed areas of consolidation with air bronchogram (24/28), decreased attenuation in the areas of consolidation (16/28), ground-glass opacities (3/28) and crazy-paving pattern (1/28). In the analysis of the bronchoalveolar lavage fluid, Sudan staining revealed foamy macrophages, confirming the diagnosis of lipoid pneumonia. After treatment with multiple bronchoalveolar lavages (mean = 9.6), 20 children became asymptomatic, 18 of those presenting normal tomographic images. CONCLUSIONS: A diagnosis of lipoid pneumonia should be considered in patients with chronic refractory pneumonia or TB, especially if there is a history of mineral oil ingestion. Bronchoscopy with multiple bronchoalveolar lavages was an efficient treatment for the clearance of mineral oil from the lung parenchyma and the prevention of fibrosis. This strategy contributed to reducing the morbidity of lipoid pneumonia, which remains a rare diagnosis.
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Bronchoalveolar Lavage/methods , Pneumonia, Lipid , Bronchoalveolar Lavage/standards , Constipation/drug therapy , Diagnosis, Differential , Mineral Oil/adverse effects , Mineral Oil/therapeutic use , Pneumonia, Lipid/chemically induced , Pneumonia, Lipid/diagnosis , Pneumonia, Lipid/therapy , Tomography, X-Ray Computed , Tuberculosis, Pulmonary/diagnosisABSTRACT
OBJETIVO: Apresentar os aspectos na tomografia computadorizada de alta resolução do tórax da pneumonia lipoídica exógena por aspiração de óleo mineral, em pacientes adultos MATERIAIS E MÉTODOS: Foram estudados oito pacientes adultos - quatro mulheres e quatro homens - com média de idade de 69,4 anos, todos usuários de óleo mineral para tratamento de constipação intestinal. Os exames foram avaliados por dois radiologistas, de forma independente RESULTADOS: Os achados tomográficos mais comuns foram as consolidações com áreas de densidade de gordura de permeio, e o padrão de pavimentação em mosaico. As lesões foram bilaterais em seis pacientes, e unilaterais em dois CONCLUSÃO: O encontro de consolidações pulmonares com áreas de densidade de gordura de permeio, associado à história clínica do uso de óleo mineral, é diagnóstico de pneumonia lipoídica exógena.
OBJECTIVE: The present study was aimed at describing the findings on high-resolution computed tomography in patients with exogenous lipoid pneumonia secondary to mineral oil aspiration MATERIALS AND METHODS: Eight adult patients - four men and four women - with mean age of 69.4 years were studied. All of the patients were users of mineral oil for treating intestinal constipation. High-resolution computed tomography studies of these patients were blindly evaluated by two radiologists. RESULTS: Air-space consolidation with areas of fat density and crazy paving pattern were the most frequent findings. The lesions were bilateral in six cases and unilateral in two CONCLUSION: Air-space consolidation with areas of fat density, associated with a clinical history of mineral oil ingestion virtually indicates a diagnosis of exogenous lipoid pneumonia.
Subject(s)
Humans , Male , Female , Middle Aged , Aged, 80 and over , Constipation , Mineral Oil/adverse effects , Pneumonia, Lipid/diagnosis , Pneumonia, Lipid/etiology , Pneumonia, Aspiration/diagnosis , Lung/physiopathology , Tomography, X-Ray ComputedABSTRACT
A pneumonia lipóide é uma doença rara, resultante da microaspiração de formulações lipídicas. Para seu diagnóstico, o grau de suspeição clínica deve ser elevado. Relata-se o caso de uma mulher com passado de câncer de mama, apresentando dispnéia e tosse progressivas e infiltrado pulmonar bilateral na radiografia. A suspeita de linfangite carcinomatosa com indicação de quimioterapia foi questionada por achados não usuais na tomografia computadorizada de alta resolução e história de ingestão crônica de laxantes contendo óleo mineral. A biópsia pulmonar confirmou pneumonia lipóide, que deve ser considerada em pacientes com pneumopatia difusa e exposição a potenciais agentes causadores.
Lipoid pneumonia is a rare disease resulting from the micro-aspiration of lipid formulations. Making a diagnosis of lipoid pneumonia requires a high degree of clinical suspicion. Herein, we report the case of a female patient with a history of breast cancer, presenting progressive dyspnea and cough, together with radiological findings of bilateral pulmonary infiltrate. The working diagnosis of lymphangitic carcinomatosis, for which chemotherapy would be indicated, was called into question based on the high-resolution computed tomography findings and on the fact that the patient had a history of chronic ingestion of laxatives containing mineral oil. A lung biopsy confirmed a diagnosis of lipoid pneumonia, which should always be considered in patients with diffuse lung disease having been exposed to potential causative agents.
Subject(s)
Humans , Female , Aged , Cathartics/adverse effects , Mineral Oil/adverse effects , Pneumonia, Lipid/chemically induced , Biopsy , Pneumonia, Lipid/diagnosis , Tomography, X-Ray ComputedABSTRACT
Se presenta el caso de un adulto de 19 años de edad, malabarista y manipulador de fuego quien ingresa al servicio de emergencias médicas del Hospital Dr. Rafael A. Calderón Guardia, por un cuadro súbito de dolor tóracico derecho y disnea. Se documenta derrame pleural en base pulmonar derecha y masa redondeada en base pulmonar izquierda. Inicia clínica sugestiva de bronconeumonía horas despúes, abordándosele inicialmente como neumonía adquiridad en la comunidad. Considerando sus antecedentes laborales y características clínicas, se reorienta caso y se concluye que se trata de lo que en la bibliografía médica en habla inglesa se denomina "fire-eater pneumonia", infrecuente neumonía por aspiración de la que se hace una revisión. Descriptores: neumonía lipoidea, neumonía por aspiración, neumonía en come fuego.
Subject(s)
Humans , Male , Adult , Pneumonia, Lipid/diagnosis , Pneumonia, Lipid/etiology , Pneumonia, Lipid/drug therapy , Pneumonia, Lipid/therapy , Pneumonia, Aspiration/diagnosis , Pneumonia, Aspiration/etiology , Pneumonia, Aspiration/therapy , Pneumonia/diagnosis , Pneumonia/etiology , Costa RicaABSTRACT
A pneumonia lipóide resulta, na maioria das vezes, da aspiração de óleo mineral. Tem seu diagnóstico subestimado, pois apresenta quadro clínico inespecífico ou ausente e alterações radiológicas que simulam outras doenças pulmonares. É mais freqüente na criança e no adulto debilitado, mas pode ocorrer em pessoas saudáveis. O objetivo é relatar o caso de uma lactente de dois meses, hígida, que fez uso prévio de óleo mineral, desenvolvendo pneumonia inicialmente tratada como bacteriana, mas a história compatível e a dissociação clínico-radiológica nos alertaram para o diagnóstico de pneumonia lipóide, que foi confirmado através do lavado broncoalveolar que mostrou glóbulos de gordura no interior dos macrófagos alveolares. Ressalta-se a importância deste diagnóstico nos casos de pneumonia de evolução arrastada sem resposta a antimicrobianos, especialmente em lactentes ou crianças com fatoresde risco para aspiração e com história de ingestão de óleo mineral.
Subject(s)
Humans , Female , Infant , Mineral Oil , Pneumonia, Lipid/complications , Pneumonia, Lipid/diagnosis , Pneumonia, Lipid/therapy , Signs and Symptoms , TherapeuticsABSTRACT
Two cases of lipoid pneumonia with a positive history of fat aspiration were described. Plain films showed multilobar persistent consolidation and air bronchogram. One case showed mass like lesion in right upper lobe. The diagnosis has been made with the help of clinical history and radiological findings. This was confirmed with lung biopsy in one case. Review of literature published from Saudi Arabia has been discussed. Lipoid pneumonia can result from aspiration of variety of materials including milk, mineral or vegetable oil, animal fat, and oily nasal drops. There is low incidence of lipoid pneumonia in pediatric age group in developed countries. However, in Saudi Arabia the condition continues to be a problem because of traditional practices of administration of oily substances to children in some areas of the kingdom in the believe that oil is good for blocked nose, irregular bowel habits and general well being. Sometimes, in fact, infants and children are forcibly fed such substances. The diagnosis of lipoid pneumonia is usually delayed unless parents are directly questioned about oil feeding practice. The condition is difficult to differentiate from infectious pneumonia both clinically and radiologically. The aim of this paper is to review the radiological findings in the reported cases of lipoid pneumonia in Saudi Arabia and to discuss the possible explanations of these findings with report of 2 new cases
Subject(s)
Pneumonia, Lipid/diagnosis , /diagnostic imaging , ChildABSTRACT
Se reporta el caso de una niña de 13 meses de edad, con fiebre y tos de 15 días de evolución. La radiografía de tórax muestra una densidad homogénea del hemi-tórax superior derecho. Con el diagnóstico probable de un quiste pulmonar infectado, se realizó:lobectomía superior derecha, encontrando evidencia histopatológica de una neumonía lipoidea
Subject(s)
Humans , Female , Infant, Newborn , Pneumonia, Lipid/diagnosis , PneumonectomyABSTRACT
Se presenta el caso de un lactante de 7 meses con diagnóstico de Megacolon congénito, el cual recibió tratamiento de aceite mineral por vía oral para reblandecer las heces presentando una broncoaspiración masiva. El diagnóstico se sospechó al observar los síntomas y verificar que la imagen radiográfica densa parabiliar bilateral no se modificaba a pesar de un tratamiento adecuado y se comprobó al estudiar en el microscopio la citología del cepillado y lavado bronquial. Se hace hincapié en el riesgo que existe de broncoaspiración en lactantes pequeños con enfermedades neurológicas y digestivas