Pneumonia Symptoms

Lipoid Pneumonia

Lipoid pneumonia is also called pneumonitis and it results from the aspiration of lipids, and is linked to the use of mineral oil as a laxative. Lipoid pneumonia remains relatively unfamiliar to clinicians and the disease probably goes under diagnosed. This purpose of this article is to increase physicians' awareness of lipoid pneumonia, its diagnosis and prevention.

Recent study was conducted on two illustrative cases of Lipoid pneumonia are reviewed. In an internal medicine ward, two cases of lipoid pneumonia were diagnosed within half a year. The patients were elderly and the lipoid pneumonia was associated with the use of mineral oil as a laxative agent. The computerized tomography that was conducted revealed bilateral low attenuation infiltrates, associated with a "crazy paving" pattern in one case. Both the cases were diagnosed by using Sudan Black staining procedure-in one on a transbronchial biopsy specimen, and in the other on sputum cytologic examination. Both the patients were suffering from neurologic diseases, and both were at risk of aspiration.

The clinical symptoms and signs, in both cases, continued for several months prior to diagnosis but once the use of mineral oil was discontinued, the signs and symptoms subsided. Therefore, it was concluded that elderly patients who are at risk of aspiration are susceptible to lipoid pneumonia and the condition may be under diagnosed. In most cases, mineral oil cathartics are the causative agent, therefore, an effort at primary prevention is recommended. It is suggested that the license of mineral oil for internal use can be reviewed or changed.

Exogenous lipoid pneumonia is referred to lung lesions that develop post aspiration or inhalation of animal, mineral oils or vegetable. Spickard and Hirschmann have made a reference of the circumstances under which aspiration of lipoid material occurs. The lipoid material smoothly glides down the respiratory tract, does not stimulate cough, and is not removed effectively by the cilia. Animal fats that can easily hydrolyze to fatty acids can cause more inflammation than vegetable or mineral oils. However, all types are successful in stimulating chronic granulomatous inflammation that is located in the lower or middle lobes.

Exogenous lipoid pneumonia is a condition that results from aspirating or inhaling fat-like material, such as mineral oil found in laxatives and various aerosolized industrial materials and itís occurrence is uncommon. These substances bring out a foreign body reaction, and propagate fibrosis in the lung. Symptoms are absent or nonspecific and therefore, roentgenographic findings simulate other diseases. Hence, exogenous lipoid pneumonia is often unrecognized. However, accurate historical inquiries and simple laboratory tests can help to diagnosis correctly, eradicating the offending agent, and, thus improving the lung function before serious complications develop.

Although it is a rare form of non resolving pulmonary infiltrate, exogenous lipoid pneumonia is a great mimicker. It is often mistaken for bacterial pneumonia or cancer. Many cases are diagnosed by open lung biopsy or other invasive procedures. Depending on the degree of inflammation that occurs or the type of lipid ingested, the extent of the damage to the lung varies. The damage can fulminate to necrosis and hemorrhage. Symptoms may vary and range from none to respiratory failure. In one of the cases that were studied, the patient was ingesting Vaseline Intensive Care Lotion and baby oil as laxatives. This information was confirmed only after diagnosis was made by open lung biopsy.

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