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. 2016 May 16:14:64-8.
eCollection 2016 May.

Exogenous lipoid pneumonia (ELP): when radiologist makes the difference

G Rea  1 , F Perna  2 , G Calabrese  2 , A Molino  2 , T Valente  1 , A Vatrella  3
Affiliations

Exogenous lipoid pneumonia (ELP): when radiologist makes the difference

G Rea et al. Transl Med UniSa. .

Abstract

Lipoid pneumonia is an uncommon disorder characterized by accumulation of lipid components into the interstitial and alveolar compartment. The usual classification distinguishes endogenous and exogenous and acute or chronic forms, related to the type of fats, the amount of damage and the time of exposure. We describe a case of exogenous lipoid pneumonia by inhalation of vaseline used for cleaning of the tracheostoma in a 63-year-old female, presenting as cough, worsening dyspnea in few weeks. The diagnosis was finally established with a re-evaluation of BAL with specific staining for lipids, revealing the presence of foamy macrophages lipids rich, according to HRCT findings.

Keywords: Bronchoalveolar lavage (BAL); Exogenous Lipoid pneumonia(ELP); High Resolution Computed tomography (HRCT).

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Figures

Fig 1.
Fig 1.
PA CXR : opacity poorly defined in lower right thoracic field near hemi-diaphragm.
Fig 2 a–b)
Fig 2 a–b)
HRCT scan. Multiple extended GGO areas in both lung with middle lobe consolidation.
Fig 3 a–b
Fig 3 a–b
HRCT scan (lung windows) and c (mediastinal window). Geometric areas with extensive “patchy” appearance of GGO, like crazy paving with fine contextual reticulation with peribronchial and hilar prevailing distribution in the upper lobes, middle lobe, with great extension in both lower lobes. The results of measurements made inside middle lobe consolidation showed density values consistently negative (− 80 HU) expression of lipoid pneumonia (mediastinal window).
Fig 4:
Fig 4:
Lung Ultrasound (LUS): High frequency transducer (12 Mhz) linear probe positioned on anterior right axillary line (middle lobe). Normal hyperechoic pleural line and complete absence of horizontal reverberations (A-lines) and also absence of ring down artifacts (B-lines) and comet tails.
Figura 5)
Figura 5)
Alveolar macrophages recovered by bronchoalveolar lavage. The cytoplasm is full of red-staining cytoplasmic vacuoles filled with lipid that displace the nucleus to the periphery (oil red O stain, original magnification ×400).
See this image and copyright information in PMC

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