Lipoid Pneumonia in a Gas Station Attendant

The exogenous lipoid pneumonia, uncommon in adults, is the result of the inhalation and/or aspiration of lipid material into the tracheobronchial tree. This is often confused with bacterial pneumonia and pulmonary tuberculosis due to a nonspecific clinical and radiologic picture. It presents acutely or chronically and may result in pulmonary fibrosis. We describe here a case of lipoid pneumonia in a gas station attendant who siphoned gasoline to fill motorcycles; he was hospitalized due to presenting with a respiratory infection that was hard to resolve. The patient underwent bronchoscopy with bronchoalveolar lavage, which, on cytochemical (oil red O) evaluation, was slightly positive for lipid material in the foamy cytoplasm of alveolar macrophages. Due to his occupational history and radiographic abnormalities suggestive of lipoid pneumonia, a lung biopsy was performed to confirm the diagnosis. The patient was serially treated with segmental lung lavage and showed clinical, functional, and radiological improvement.

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Treatment of exogenous lipoid pneumonia by whole lung lavage

Australian and New Zealand Journal of Medicine ◽

10.1111/j.1445-5994.1994.tb01801.x ◽

1994 ◽

Vol 24 (6) ◽

pp. 734-735 ◽

Cited By ~ 12

Author(s):

C. A. WONG ◽

M. L. WILSHER

Keyword(s):

Lung Lavage ◽

Lipoid Pneumonia ◽

Whole Lung Lavage

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Pulmonary Eosinophilic Granuloma: Electron Microscopic Detection of X-Bodies on Lung Lavage Cells and Transbronchoscopic Lung Biopsy in One Patient

Annals of Internal Medicine ◽

10.7326/0003-4819-96-2-188 ◽

1982 ◽

Vol 96 (2) ◽

pp. 188 ◽

Cited By ~ 7

Author(s):

FREDRIC C. KULLBERG

Keyword(s):

Lung Biopsy ◽

Eosinophilic Granuloma ◽

Lung Lavage ◽

Electron Microscopic ◽

Microscopic Detection

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The role of macrophages in interstitial lung diseases

European Respiratory Review ◽

10.1183/16000617.0009-2017 ◽

2017 ◽

Vol 26 (145) ◽

pp. 170009 ◽

Cited By ~ 15

Author(s):

Giulio Rossi ◽

Alberto Cavazza ◽

Paolo Spagnolo ◽

Salvatore Bellafiore ◽

Elisabetta Kuhn ◽

...

Keyword(s):

Lung Biopsy ◽

Morphological Characteristics ◽

Underlying Disease ◽

Interstitial Lung Diseases ◽

Alveolar Haemorrhage ◽

Routine Practice ◽

Lipoid Pneumonia ◽

Diffuse Panbronchiolitis ◽

Niemann Pick Disease ◽

Niemann Pick

The finding of collections of macrophages/histiocytes in lung biopsy and bronchoalveolar lavage is relatively common in routine practice. This morphological feature in itself is pathological, but the exact clinical significance and underlying disease should be evaluated together with clinical data, functional respiratory and laboratory tests and imaging studies.Morphological characteristics of macrophages and their distribution along the different pulmonary structures should be examined carefully by pathologists. Indeed, haemosiderin-laden macrophages are associated with smoking-related diseases when pigment is fine and distribution is bronchiolocentric, while alveolar haemorrhage or pneumoconiosis are the main concerns when pigment is chunky or coarse and the macrophages show an intra-alveolar or perilymphatic location, respectively. In the same way, pulmonary accumulation of macrophages with foamy cytoplasm is generally associated with pathologies leading to broncho-bronchiolar obstruction (e.g.diffuse panbronchiolitis, hypersensitivity pneumonia or cryptogenic organising pneumonia) or alternatively to exogenous lipoid pneumonia, some drug toxicity (e.g.amiodarone exposure or toxicity) and metabolic disorders (e.g.type B Niemann–Pick disease).This pathology-based perspectives article is aimed at concisely describing the diagnostic possibilities when faced with collection of macrophages in lung biopsy and cytology.

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Supramicron-sized particle clearance from alveoli: route and kinetics

Journal of Applied Physiology ◽

10.1152/jappl.1990.69.4.1302 ◽

1990 ◽

Vol 69 (4) ◽

pp. 1302-1308 ◽

Cited By ~ 17

Author(s):

E. G. Langenback ◽

E. H. Bergofsky ◽

J. G. Halpern ◽

W. M. Foster

Keyword(s):

Lymphatic Drainage ◽

Lung Lavage ◽

Tracheobronchial Tree ◽

Scintillation Camera ◽

Balance Study ◽

Whole Lung Lavage ◽

Particle Clearance ◽

Median Diameter ◽

Count Median Diameter ◽

Kinetics Of

Particles inhaled and deposited in the alveoli of the lung, i.e., distal to the tracheobronchial mucociliary escalator, may theoretically be cleared by several routes, including solubilization, lymphatic drainage, and the mucociliary pathway. We studied the clearance routes and kinetics of an inert insoluble carbonized polystyrene particle of supramicron size (2.85 micron count median diameter) tagged with 57Co (half-life 270 days) in the adult unanesthetized sheep. The rate of particle clearance, assessed by gamma scintillation camera of the whole lung, showed a three-exponential function, comprising a rapid initial phase in the first 44 h of clearance for tracheobronchial deposition followed by a slower phase of mostly alveolar clearance in the next 30 days and a final phase of very slow relatively pure alveolar clearance. A balance study of particle route during clearance and autopsy of regional thoracic lymph nodes, blood, liver, and spleen demonstrated that this supramicron-sized particle cleared from alveoli predominantly via the mucociliary escalator of the tracheobronchial tree. Whole-lung lavage studies showed particle and macrophage recovery rates suggesting a sequestered state for alveolar-deposited particles, which may partly account for their slow clearance rates. The failure to find interstitial penetration by alveolar-deposited particles indicates that the macrophages engulfing these particles, at low particle burdens, travel normally in only one direction, i.e., from interstitium to alveolus and then to the mucociliary escalator.

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Lung Biopsy Findings in Severe Pulmonary Illness Associated With E-Cigarette Use (Vaping)

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz182 ◽

2019 ◽

Cited By ~ 18

Author(s):

Sanjay Mukhopadhyay ◽

Mitra Mehrad ◽

Pedro Dammert ◽

Andrea V Arrossi ◽

Rakesh Sarda ◽

...

Keyword(s):

Acute Lung Injury ◽

Lung Injury ◽

Lung Biopsy ◽

Diffuse Alveolar Damage ◽

Lung Damage ◽

Cigarette Use ◽

Lipoid Pneumonia ◽

Lung Biopsies ◽

Severe Lung

Abstract Objectives The aim of this report is to describe the lung biopsy findings in vaping-associated pulmonary illness. Methods Lung biopsies from eight patients with vaping-associated pulmonary illness were reviewed. Results The biopsies were from eight men (aged 19-61 years) with respiratory symptoms following e-cigarette use (vaping). Workup for infection was negative in all cases, and there was no evidence for other etiologies. Imaging showed diffuse bilateral ground-glass opacities in all patients. Most recovered with corticosteroid therapy, while one died. Lung biopsies (seven transbronchial, one surgical) showed acute lung injury, including organizing pneumonia and/or diffuse alveolar damage. Common features were fibroblast plugs, hyaline membranes, fibrinous exudates, type 2 pneumocyte hyperplasia, and interstitial organization. Some cases featured a sparse interstitial chronic inflammatory infiltrate. Although macrophages were present within the airspaces in all cases, this feature was not prominent, and findings typical of exogenous lipoid pneumonia were absent. Conclusions The histopathology of acute pulmonary illness related to e-cigarette use (vaping) is characterized by acute lung injury patterns, supporting the contention that vaping can cause severe lung damage.

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Bronchoscopic Lung Biopsy in the Diagnosis of Exogenous Lipoid Pneumonia

Journal of Bronchology ◽

10.1097/00128594-199807000-00006 ◽

1998 ◽

Vol 5 (3) ◽

pp. 204-208

Author(s):

Pedro S. Grynblat ◽

Claudia E. Bäcker

Keyword(s):

Lung Biopsy ◽

Lipoid Pneumonia

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Primary pulmonary alveolar proteinosis

Vojnosanitetski pregled ◽

10.2298/vsp1211005s ◽

2012 ◽

Vol 69 (11) ◽

pp. 1005-1008 ◽

Cited By ~ 1

Author(s):

Sanja Sarac ◽

Rade Milic ◽

Lidija Zolotarevski ◽

Slobodan Acimovic ◽

Ilija Tomic ◽

...

Keyword(s):

Lung Biopsy ◽

Pulmonary Alveolar Proteinosis ◽

Lung Lavage ◽

Open Lung Biopsy ◽

Adequate Treatment ◽

Open Lung ◽

Uncommon Disease ◽

Colonystimulating Factor ◽

Alveolar Proteinosis ◽

Bilateral Lung

Introduction. Pulmonary alveolar proteinosis is an uncommon disease characterized by the accumulation of surfactant proteins and phospholipids within the alveolar spaces. Acquired disease can be idiopathic (primary) and secondary. The prevalence of acquired pulmonary alveolar proteinosis is about 0.37 per 100,000 persons. Common symptoms are dyspnea and cough. Chest X-ray shows bilateral perihilar infiltrates. Open-lung biopsy is the gold standard for the diagnosis. Treatment includes whole-lung lavage, application of granulocyte-macrophage colonystimulating factor and lung transplantation. Case report. We reported a 51 year-old man with primary form of the disease. It was the second case of this extremely rare disease in the past 30 years in our clinic. The symptoms were longlasting dry cough, fever and physical deterioration. Chest Xray revealed bilateral pulmonary infiltrates; computed tomography showed patchy ground-glass opacification with interlobular thickening. The diagnosis was established by open lung biopsy. Additional tests were performed to exclude secondary form of the disease. Conclusion. We presented a rare clinical entity with typical clinical features and clinical and radiological course of the disease, in order to improve differential diagnostic approach to patients with bilateral lung infiltrations. In patients with pulmonary alveolar proteinosis timely diagnosis and adequate treatment can improve a prognosis.

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