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• W2043157468 abstract "Lipoid pneumonia results from the pulmonary accumulation of endogenous or exogenous lipids. Host tissue reactions to the inhaled substances differ according to their chemical characteristics. Symptoms can vary significantly among individuals, ranging from asymptomatic to severe, life-threatening disease. Acute, sometimes fatal, cases can occur, but the disease is usually indolent. Possible complications include superinfection by nontuberculous mycobacteria, pulmonary fibrosis, respiratory insufficiency, cor pulmonale, and hypercalcemia. The radiological findings are nonspecific, and the disease presents with variable patterns and distribution. For this reason, lipoid pneumonia may mimic many other diseases. The diagnosis of exogenous lipoid pneumonia is based on a history of exposure to oil, characteristic radiological findings, and the presence of lipid-laden macrophages on sputum or BAL analysis. High-resolution computed tomography (HRCT) is the best imaging modality for the diagnosis of lipoid pneumonia. The most characteristic CT finding in LP is the presence of negative attenuation values within areas of consolidation. There are currently no studies in the literature that define the best therapeutic option. However, there is a consensus that the key measure is identifying and discontinuing exposure to the offending agent. Treatment in patients without clinical symptoms remains controversial, but in patients with diffuse pulmonary damage, aggressive therapies have been reported. They include whole lung lavage, systemic corticosteroids, and thoracoscopy with surgical debridement. Lipoid pneumonia results from the pulmonary accumulation of endogenous or exogenous lipids. Host tissue reactions to the inhaled substances differ according to their chemical characteristics. Symptoms can vary significantly among individuals, ranging from asymptomatic to severe, life-threatening disease. Acute, sometimes fatal, cases can occur, but the disease is usually indolent. Possible complications include superinfection by nontuberculous mycobacteria, pulmonary fibrosis, respiratory insufficiency, cor pulmonale, and hypercalcemia. The radiological findings are nonspecific, and the disease presents with variable patterns and distribution. For this reason, lipoid pneumonia may mimic many other diseases. The diagnosis of exogenous lipoid pneumonia is based on a history of exposure to oil, characteristic radiological findings, and the presence of lipid-laden macrophages on sputum or BAL analysis. High-resolution computed tomography (HRCT) is the best imaging modality for the diagnosis of lipoid pneumonia. The most characteristic CT finding in LP is the presence of negative attenuation values within areas of consolidation. There are currently no studies in the literature that define the best therapeutic option. However, there is a consensus that the key measure is identifying and discontinuing exposure to the offending agent. Treatment in patients without clinical symptoms remains controversial, but in patients with diffuse pulmonary damage, aggressive therapies have been reported. They include whole lung lavage, systemic corticosteroids, and thoracoscopy with surgical debridement. Several pulmonary complications may be caused by the aspiration of different substances into the airways and airspaces. Lipoid pneumonia (LP) is an uncommon condition that results from the pulmonary accumulation of fatlike compounds of animal, vegetable or mineral origin.1Franquet T. Giménez A. Bordes R. Rodriguez-Arias J.M. Castella J. The crazy-paving pattern in exogenous lipoid pneumonia: CT-pathologic correlation.AJR. 1998; 170: 315-317Crossref PubMed Scopus (92) Google Scholar, 2Laurent F. Philippe J.C. Vergier B. et al.Exogenous lipoid pneumonia: HRCT, MR, and pathologic findings.Eur Radiol. 1999; 9: 1190-1196Crossref PubMed Scopus (77) Google Scholar It can be classified into endogenous and exogenous forms. In endogenous form, also called “cholesterol” or “golden” pneumonia, the fatlike materials are derived from the lung itself.3Gondouin A. Manzoni P.H. Ranfaing E. et al.Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France.Eur Respir J. 1996; 9: 1463-1469Crossref PubMed Scopus (189) Google Scholar, 4Sharma A. Ohri S. Bambery P. Singh S. Idiopathic endogenous lipoid pneumonia.Indian J Chest Dis Allied Sci. 2006; 48: 143-145PubMed Google Scholar It usually develops when lipids that normally reside in the lung tissue – most commonly cholesterol and its esters – are released from destroyed alveolar cell walls distal to an obstructive airway lesion or from lung tissue damaged by a suppurative process, or due to lipid storage diseases.3Gondouin A. Manzoni P.H. Ranfaing E. et al.Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France.Eur Respir J. 1996; 9: 1463-1469Crossref PubMed Scopus (189) Google Scholar, 5Chin N.K. Hui K.P. Sinnah R. Chan T.B. Idiopathic lipoid pneumonia in an adult treated with prednisolone.Chest. 1994; 105: 956-957Crossref PubMed Scopus (55) Google Scholar, 6Spickard A. Hirchmann J.V. Exogenous lipoid pneumonia.Arch Intern Med. 1994; 154: 686-692Crossref PubMed Google Scholar The exogenous form can be classified into acute and chronic. Chronic exogenous LP results from long-term, recurrent inhalation exposure to oil, while the acute form is secondary to accidental aspiration of a large quantity of lipid material over a short period of time.7Baron S.R. Haramati L.D. Riviera V.T. Radiological and clinical findings in acute and chronic exogenous lipoid pneumonia.J Thorac Imaging. 2003; 18: 217-224Crossref PubMed Scopus (86) Google Scholar, 8Gentina T. Tillie-Leblond I. Birolleau S. et al.Fire-eater’s lung: seventeen cases and a review of the literature.Medicine (Baltimore). 2001; 80: 291-297Crossref PubMed Scopus (49) Google Scholar Exogenous LP is caused by the inhalation of oils present in food, radiographic contrast media, or oil-based medications such as laxatives.1Franquet T. Giménez A. Bordes R. Rodriguez-Arias J.M. Castella J. The crazy-paving pattern in exogenous lipoid pneumonia: CT-pathologic correlation.AJR. 1998; 170: 315-317Crossref PubMed Scopus (92) Google Scholar, 9Asnis D.S. Saltzman H.P. Melchert A. Shark oil pneumonia. An overlooked entity.Chest. 1993; 103: 976-977Crossref PubMed Scopus (23) Google Scholar Traditional oil-based popular medicines are used to treat various diseases in children, and are often associated with respiratory diseases.10Hoffman L.R. Yen E.H. Kanne J.P. Effmann E.L. Gibson R.L. Van Niel C.W. Lipoid pneumonia due to Mexican folk remedies: cultural barriers to diagnosis.Arch Pediatr Adolesc Med. 2005; 159: 1043-1048Crossref PubMed Scopus (23) Google Scholar In adults, most cases result from the use of oil-based laxatives (olive oil, cod liver oil and paraffin oil) for the treatment of constipation, followed by the nasal instillation of oily products for chronic rhinopharyngeal diseases.3Gondouin A. Manzoni P.H. Ranfaing E. et al.Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France.Eur Respir J. 1996; 9: 1463-1469Crossref PubMed Scopus (189) Google Scholar, 11Franquet T. Giménez A. Rosón N. Torrubia S. Sabaté J.M. Pérez C. Aspiration diseases: findings, pitfalls, and differential diagnosis.RadioGraphics. 2000; 20: 673-685Crossref PubMed Scopus (152) Google Scholar Chronic constipation is a frequent symptom in the pediatric population. Mineral oil is also used in children for partial small bowel obstruction by Ascaris lumbricoides.12de Oliveira G.A. Del Caro S.R. Bender Lamego C.M. Merçon de Vargas P.R. Vervloet V.E. Radiographic plain film and CT findings in lipoid pneumonia in infants following aspiration of mineral oil used in the treatment of partial small bowel obstruction by Ascaris lumbricoides.Pediatr Radiol. 1985; 15: 157-160Crossref PubMed Scopus (31) Google Scholar, 13Azevedo Sias S. Oliveira Caetano R. Dutra Comarella J. de Oliveira E. Santos Ferreira A. Quirico-Santos T. Successful treatment of lipoid pneumonia associated with bowel obstruction by Ascaris lumbricoides.J Trop Pediatrics. 2009; https://doi.org/10.1093/tropej/fmp119Crossref PubMed Scopus (4) Google Scholar However, it must be remembered that infants and small children often object vigorously to ingest the oil, resulting in gagging that precipitates aspiration.14Bandla H.P. Davis S.H. Hopkins N.E. Lipoid pneumonia: a silent complication of mineral oil aspiration.Pediatrics. 1999; 103: E19Crossref PubMed Scopus (95) Google Scholar Different substances called pyrofluids are used by “fire-eaters” (performers that “swallow” or “spit” fire). The most common is the petroleum-derivative kerdan, characterized by its reduced viscosity and rapid diffusion throughout the bronchial tree. After flame blowing, the fire-eater takes a deep breath, and can aspirate the kerdan remaining in the mouth.8Gentina T. Tillie-Leblond I. Birolleau S. et al.Fire-eater’s lung: seventeen cases and a review of the literature.Medicine (Baltimore). 2001; 80: 291-297Crossref PubMed Scopus (49) Google Scholar It is noteworthy that fire-eater pneumonitis has morphological, radiographic and clinical profiles entirely different from chronic lipoid pneumonia. The history of accidental aspiration during “fire-eating” demonstrations is characteristic. Symptoms occur in the first 12 h after aspiration, and include chest pain, dyspnea, cough, fever, and hemoptysis. The disease has, in most of cases, a favorable evolution. The HRCT usually shows bilateral lung consolidations, often associated with cavitary lesions (pneumatoceles).8Gentina T. Tillie-Leblond I. Birolleau S. et al.Fire-eater’s lung: seventeen cases and a review of the literature.Medicine (Baltimore). 2001; 80: 291-297Crossref PubMed Scopus (49) Google Scholar Other less commonly reported causes of LP include: aspiration of milk,15Bromer R.S. Wolman I.J. Lipoid pneumonia in infants and children.Radiology. 1939; 1: 1-7Google Scholar, 16Pinkerton H. Oils and fats – Their entrance into and fats in the lungs of infants and children: a clinical and pathologic report.AJDC. 1928; 33: 259-285Google Scholar poppy seed oil,3Gondouin A. Manzoni P.H. Ranfaing E. et al.Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France.Eur Respir J. 1996; 9: 1463-1469Crossref PubMed Scopus (189) Google Scholar and egg yolk16Pinkerton H. Oils and fats – Their entrance into and fats in the lungs of infants and children: a clinical and pathologic report.AJDC. 1928; 33: 259-285Google Scholar; occupational exposure to paraffin (paraffin droplets released by machines) in cardboard crockery factories17Descatha A. Mompoint D. Ameille J. Occupacional paraffin-induced pulmonary fibrosis: a 25-year follow-up.Occup Med. 2006; 56: 504-506Crossref Scopus (4) Google Scholar; oil blasting in industries; use of spray paint18Libuse H.M. Rohatgi P.K. Diffuse cholesterol granulomatous pneumonitis in a patient exposed to spray paints.Chest. 2000; 118: 303SCrossref PubMed Scopus (40) Google Scholar; contact with plastic paint19Fernández A.A. Díez J.M. Vime R.L. Santos D.G. Botello L.N. Chinarro B.J. Neumonía lipoidea em relación com exposición laboral a pinturas.Arch Bronconeumol. 2003; 39: 133-135Crossref PubMed Google Scholar; aspiration of oils used in industry as lubricants and cutting fluids, in either fluid or spray form, for turning, milling and grinding operations3Gondouin A. Manzoni P.H. Ranfaing E. et al.Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France.Eur Respir J. 1996; 9: 1463-1469Crossref PubMed Scopus (189) Google Scholar; cleaning of new cars protected by paraffin, using hot water generated by compressed air jets20Pujol J.L. Barneon G. Bousquet J. Michel F.B. Godard P. Interstitial disease induced by occupational exposure to paraffin.Chest. 1990; 97: 234-236Crossref PubMed Scopus (18) Google Scholar; cleaning oil-containing vats; siphoning diesel fuel19Fernández A.A. Díez J.M. Vime R.L. Santos D.G. Botello L.N. Chinarro B.J. Neumonía lipoidea em relación com exposición laboral a pinturas.Arch Bronconeumol. 2003; 39: 133-135Crossref PubMed Google Scholar, 21Hussain I.R. Edenborough F.P. Wilson R.S. Stableforth D.E. Severe lipoid pneumonia following attempted suicide by mineral oil immersion.Thorax. 1996; 51: 652-653Crossref PubMed Scopus (24) Google Scholar; smoking blackfat tobacco, a Kentucky product coated with oil and petroleum jelly to flavor and moisturize the leaf6Spickard A. Hirchmann J.V. Exogenous lipoid pneumonia.Arch Intern Med. 1994; 154: 686-692Crossref PubMed Google Scholar; accidental aspiration of vaseline used in the placement of nasogastric tubes22Mora R.B. Martinez P.M. Martinez M.C. Garcia L.A. Cruz M.L. Gascón F.S. Neumonía lipoidea aguda debida a la aspiración accidental de vaselina utilizada em um sondaje nasogástrico.Arch Bronconeumol. 2000; 36: 485-487PubMed Google Scholar; longstanding use of petroleum jelly (Vaseline, Vicks™) at bedtime23Brown A.C. Slocum P.C. Putthoff S.L. Wallace W.E. Foresman B.H. Exogenous lipoid pneumonia due to nasal application of petroleum jelly.Chest. 1994; 106: 1311-1312Google Scholar; aspiration of spray lubricant WD-40 (very popular oil spray, for home use)24Glynn K.P. Gale N. Exogenous lipoid pneumonia due to inhalation of spray lubricant (DW-40 lung).Chest. 1990; 97: 1265-1266Crossref PubMed Scopus (13) Google Scholar; excessive use of lip balm (Chap Stick, a lipstick that contains petrolatums and lipids) and of flavored lip gloss6Spickard A. Hirchmann J.V. Exogenous lipoid pneumonia.Arch Intern Med. 1994; 154: 686-692Crossref PubMed Google Scholar; and facial application of petrolatum for erythrodermic psoriasis.25Cohen M.A. Galbut B. Kerdel F.A. Exogenous lipoid pneumonia caused by facial application of petrolatum.J Am Acad Dermatol. 2003; 49: 1128-1130Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar Some authors also described the development of LP secondary to suicide attempt by mineral oil immersion.21Hussain I.R. Edenborough F.P. Wilson R.S. Stableforth D.E. Severe lipoid pneumonia following attempted suicide by mineral oil immersion.Thorax. 1996; 51: 652-653Crossref PubMed Scopus (24) Google Scholar, 26Noguè S. Sanz P. Borondo J.C. Picón M. Red G. Mestre G. Fatal lipoid pneumonia due to bronco-aspiration of isoparaffin after ingestion of an organophosphate insecticide.Acta Anaesthesiol Scand. 2003; 47: 777-779Crossref PubMed Scopus (11) Google Scholar Factors that increase the risk of exogenous LP include extremes of age; anatomical or structural abnormalities of the pharynx and esophagus, such as Zenker diverticulum, gastroesophageal fistula, hiatal hernia, gastroesophageal reflux, achalasia; psychiatric disorders; episodes of loss of consciousness; neuromuscular disorders that result in swallowing dysfunction or affect the cough reflex; and, particularly in children, forced oil intake.1Franquet T. Giménez A. Bordes R. Rodriguez-Arias J.M. Castella J. The crazy-paving pattern in exogenous lipoid pneumonia: CT-pathologic correlation.AJR. 1998; 170: 315-317Crossref PubMed Scopus (92) Google Scholar, 7Baron S.R. Haramati L.D. Riviera V.T. Radiological and clinical findings in acute and chronic exogenous lipoid pneumonia.J Thorac Imaging. 2003; 18: 217-224Crossref PubMed Scopus (86) Google Scholar, 27Lee J.Y. Lee K.S. Kim T.S. et al.Squalene-induced extrinsic lipoid pneumonia: serial radiologic findings in nine patients.J Comput Assist Tomogr. 1999; 23: 730-735Crossref PubMed Scopus (32) Google Scholar, 28Lee K.H. Kim W.S. Cheon J.E. Seo J.B. Kim I.O. Yeon K.M. Squalene aspiration pneumonia in children: radiographic and CT findings as the first clue to diagnosis.Pediatr Radiol. 2005; 35: 619-623Crossref PubMed Scopus (17) Google Scholar, 29Lee K.S. Müller N.L. Hale V. Newell Jr., J.D. Lynch D.A. Im J.G. Lipoid pneumonia: CT findings.J Comput Assist Tomogr. 1995; 19: 48-51Crossref PubMed Scopus (58) Google Scholar Because they float on the top of stomach fluids, oils may enter the airway when aspirated by patients with gastroesophageal reflux disease.3Gondouin A. Manzoni P.H. Ranfaing E. et al.Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France.Eur Respir J. 1996; 9: 1463-1469Crossref PubMed Scopus (189) Google Scholar, 6Spickard A. Hirchmann J.V. Exogenous lipoid pneumonia.Arch Intern Med. 1994; 154: 686-692Crossref PubMed Google Scholar, 7Baron S.R. Haramati L.D. Riviera V.T. Radiological and clinical findings in acute and chronic exogenous lipoid pneumonia.J Thorac Imaging. 2003; 18: 217-224Crossref PubMed Scopus (86) Google Scholar, 8Gentina T. Tillie-Leblond I. Birolleau S. et al.Fire-eater’s lung: seventeen cases and a review of the literature.Medicine (Baltimore). 2001; 80: 291-297Crossref PubMed Scopus (49) Google Scholar, 27Lee J.Y. Lee K.S. Kim T.S. et al.Squalene-induced extrinsic lipoid pneumonia: serial radiologic findings in nine patients.J Comput Assist Tomogr. 1999; 23: 730-735Crossref PubMed Scopus (32) Google Scholar, 30Lee J.S. Im J.C. Song K.S. Seo J.B. Lim T.H. Exogenous lipoid pneumonia: high-resolution CT findings.Eur Radiol. 1999; 9: 287-291Crossref PubMed Scopus (46) Google Scholar Critically ill patients receiving nasoenteric feeding may easily develop aspiration pneumonia, as a result of a retrograde regurgitation of feeding solutions.31Umuroğlu T. Takil A. Irmak P. et al.Effects of multiple pulmonary aspirations of enteral solutions on lung tissue damage.Clin Nutr. 2006; 25: 45-50Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar In some countries the digestive form of Chagas disease, where patients with megacolon have severe and prolonged periods of constipation (over 60 days), should also be remembered.32Garcia S.B. Aranha A.L. Garcia F.R. et al.A retrospective study of histopathological findings in 894 cases of megacolon: what is the relationship between megacolon and colonic cancer?.Rev Inst Med Trop São Paulo. 2003; 45: 91-93Crossref PubMed Google Scholar, 33Rochitte C.E. Nacif M.S. Oliveira Jr., A.C. Siqueira-Batista R. Marchiori E. Uellendahl M. Higuchi M.L. Cardiac magnetic resonance in Chaga’s disease.Artif Organs. 2007; 31: 259-267Crossref PubMed Scopus (38) Google Scholar The combination of two factors (constipation caused by functional disorder of colon, and tendency to aspiration due to megaesophagus) enhances the risk of lipoid pneumonia in patients with Chagas disease.34Marchiori E. Zanetti G. Nobre L.F. Takayassu T.C. Irion K.L. Lipoid pneumonia complicating chagasic megaesophagus. High-resolution CT findings.J Thorac Imaging. 2010; 25: 179-182Crossref PubMed Scopus (6) Google Scholar In many cases there is no predisposing condition and the excessive use of oily substances is the presumed cause.1Franquet T. Giménez A. Bordes R. Rodriguez-Arias J.M. Castella J. The crazy-paving pattern in exogenous lipoid pneumonia: CT-pathologic correlation.AJR. 1998; 170: 315-317Crossref PubMed Scopus (92) Google Scholar, 2Laurent F. Philippe J.C. Vergier B. et al.Exogenous lipoid pneumonia: HRCT, MR, and pathologic findings.Eur Radiol. 1999; 9: 1190-1196Crossref PubMed Scopus (77) Google Scholar, 29Lee K.S. Müller N.L. Hale V. Newell Jr., J.D. Lynch D.A. Im J.G. Lipoid pneumonia: CT findings.J Comput Assist Tomogr. 1995; 19: 48-51Crossref PubMed Scopus (58) Google Scholar In adults, 25% of cases of lipoid pneumonia occur in individuals without any predisposing factors.3Gondouin A. Manzoni P.H. Ranfaing E. et al.Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France.Eur Respir J. 1996; 9: 1463-1469Crossref PubMed Scopus (189) Google Scholar, 14Bandla H.P. Davis S.H. Hopkins N.E. Lipoid pneumonia: a silent complication of mineral oil aspiration.Pediatrics. 1999; 103: E19Crossref PubMed Scopus (95) Google Scholar It is noteworthy that the aspiration of mineral oil usually occurs unnoticed because it does not induce reactive responses in the airways, such as glottic closure or cough. These substances introduced into the nose can easily and silently reach the bronchial tree of sleeping patients without eliciting a normal protective cough reflex11Franquet T. Giménez A. Rosón N. Torrubia S. Sabaté J.M. Pérez C. Aspiration diseases: findings, pitfalls, and differential diagnosis.RadioGraphics. 2000; 20: 673-685Crossref PubMed Scopus (152) Google Scholar and may impair mucociliary transport, subsequently reducing their clearance from the respiratory tract.3Gondouin A. Manzoni P.H. Ranfaing E. et al.Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France.Eur Respir J. 1996; 9: 1463-1469Crossref PubMed Scopus (189) Google Scholar, 14Bandla H.P. Davis S.H. Hopkins N.E. Lipoid pneumonia: a silent complication of mineral oil aspiration.Pediatrics. 1999; 103: E19Crossref PubMed Scopus (95) Google Scholar The clinical symptoms are nonspecific, and vary according to the patient’s age, duration of oil intake, and the amount and quality of oil aspirated.14Bandla H.P. Davis S.H. Hopkins N.E. Lipoid pneumonia: a silent complication of mineral oil aspiration.Pediatrics. 1999; 103: E19Crossref PubMed Scopus (95) Google Scholar, 35Midula F. Strappini P.M. Ascoli V. et al.Bronchoalveolar lavage cell analysis in a child with chronic lipid pneumonia.Eur Respir J. 1998; 11: 239-242Crossref PubMed Scopus (35) Google Scholar The time of exposure to oil varies widely in the cases described in the literature, reaching up to several years.3Gondouin A. Manzoni P.H. Ranfaing E. et al.Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France.Eur Respir J. 1996; 9: 1463-1469Crossref PubMed Scopus (189) Google Scholar, 7Baron S.R. Haramati L.D. Riviera V.T. Radiological and clinical findings in acute and chronic exogenous lipoid pneumonia.J Thorac Imaging. 2003; 18: 217-224Crossref PubMed Scopus (86) Google Scholar, 8Gentina T. Tillie-Leblond I. Birolleau S. et al.Fire-eater’s lung: seventeen cases and a review of the literature.Medicine (Baltimore). 2001; 80: 291-297Crossref PubMed Scopus (49) Google Scholar, 30Lee J.S. Im J.C. Song K.S. Seo J.B. Lim T.H. Exogenous lipoid pneumonia: high-resolution CT findings.Eur Radiol. 1999; 9: 287-291Crossref PubMed Scopus (46) Google Scholar, 36Annobil S.H. Morad N.A. Khurana P. Kameswaran M. Ogunbiyi O. al-Malki T. Reaction of human lungs to aspirated animal fat (ghee): a clinicopathological study.Virchows Arch. 1995; 426: 301-305Crossref PubMed Scopus (15) Google Scholar, 37Marchiori E. Zanetti G. Mano C.M. Irion K.L. Daltro P.A. Hochhegger B. Lipoid Pneumonia in 53 patients after aspiration of mineral oil: comparison of high-resolution computed tomography findings in adults and children.J Comput Assist Tomogr. 2010; 34: 9-12Crossref PubMed Scopus (32) Google Scholar In almost all studies, the amount of oil consumed was not quantified.3Gondouin A. Manzoni P.H. Ranfaing E. et al.Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France.Eur Respir J. 1996; 9: 1463-1469Crossref PubMed Scopus (189) Google Scholar, 7Baron S.R. Haramati L.D. Riviera V.T. Radiological and clinical findings in acute and chronic exogenous lipoid pneumonia.J Thorac Imaging. 2003; 18: 217-224Crossref PubMed Scopus (86) Google Scholar, 8Gentina T. Tillie-Leblond I. Birolleau S. et al.Fire-eater’s lung: seventeen cases and a review of the literature.Medicine (Baltimore). 2001; 80: 291-297Crossref PubMed Scopus (49) Google Scholar, 30Lee J.S. Im J.C. Song K.S. Seo J.B. Lim T.H. Exogenous lipoid pneumonia: high-resolution CT findings.Eur Radiol. 1999; 9: 287-291Crossref PubMed Scopus (46) Google Scholar, 36Annobil S.H. Morad N.A. Khurana P. Kameswaran M. Ogunbiyi O. al-Malki T. Reaction of human lungs to aspirated animal fat (ghee): a clinicopathological study.Virchows Arch. 1995; 426: 301-305Crossref PubMed Scopus (15) Google Scholar, 37Marchiori E. Zanetti G. Mano C.M. Irion K.L. Daltro P.A. Hochhegger B. Lipoid Pneumonia in 53 patients after aspiration of mineral oil: comparison of high-resolution computed tomography findings in adults and children.J Comput Assist Tomogr. 2010; 34: 9-12Crossref PubMed Scopus (32) Google Scholar In the elderly, these pneumonias are usually chronic, progressive, and asymptomatic. For this reason, it may be discovered only as an incidental autopsy finding. Respiratory failure requiring ventilatory support is an unusual presentation of the disease.21Hussain I.R. Edenborough F.P. Wilson R.S. Stableforth D.E. Severe lipoid pneumonia following attempted suicide by mineral oil immersion.Thorax. 1996; 51: 652-653Crossref PubMed Scopus (24) Google Scholar In children, massive aspiration may present with acute clinical manifestations and early radiological findings.36Annobil S.H. Morad N.A. Khurana P. Kameswaran M. Ogunbiyi O. al-Malki T. Reaction of human lungs to aspirated animal fat (ghee): a clinicopathological study.Virchows Arch. 1995; 426: 301-305Crossref PubMed Scopus (15) Google Scholar, 38Requena-Kassarjlan Y. An infant with respiratory distress.Clin Pediatr. 2001; 40: 507-509Crossref PubMed Scopus (5) Google Scholar Symptoms can vary significantly among individuals, ranging from asymptomatic to severe, life-threatening disease.39Zanetti G. Marchiori E. Gasparetto T.D. Escuissato D.L. Soares Souza A Jr. Lipoid pneumonia in children following aspiration of mineral oil used in the treatment of constipation: high-resolution CT findings in 17 patients.Pediatr Radiol. 2007; 37: 1135-1139Crossref PubMed Scopus (45) Google Scholar When present, symptoms are usually mild.26Noguè S. Sanz P. Borondo J.C. Picón M. Red G. Mestre G. Fatal lipoid pneumonia due to bronco-aspiration of isoparaffin after ingestion of an organophosphate insecticide.Acta Anaesthesiol Scand. 2003; 47: 777-779Crossref PubMed Scopus (11) Google Scholar Lipoid pneumonia usually presents with chronic cough, sometimes productive, and dyspnea.40Talwar A. Mayerhoff R. London D. Shah R. Stanek A. Epstein M. False-positive P.E.T. Scan in a pacient with lipoid pneumonia simulating lung cancer.Clin Nucl Med. 2004; 29: 426-428Crossref PubMed Scopus (27) Google Scholar Less common problems include chest pain, hemoptysis, weight loss, and intermittent fever. Physical examination of the chest may be normal or may present dullness to percussion, crackles, wheezes, or rhonchi.6Spickard A. Hirchmann J.V. Exogenous lipoid pneumonia.Arch Intern Med. 1994; 154: 686-692Crossref PubMed Google Scholar Most cases of lipoid pneumonia shows a discrepancy in severity between the radiological and clinical findings. Patients are often asymptomatic with extensive imaging findings, which are discovered incidentally on routine chest radiographs.2Laurent F. Philippe J.C. Vergier B. et al.Exogenous lipoid pneumonia: HRCT, MR, and pathologic findings.Eur Radiol. 1999; 9: 1190-1196Crossref PubMed Scopus (77) Google Scholar, 6Spickard A. Hirchmann J.V. Exogenous lipoid pneumonia.Arch Intern Med. 1994; 154: 686-692Crossref PubMed Google Scholar, 28Lee K.H. Kim W.S. Cheon J.E. Seo J.B. Kim I.O. Yeon K.M. Squalene aspiration pneumonia in children: radiographic and CT findings as the first clue to diagnosis.Pediatr Radiol. 2005; 35: 619-623Crossref PubMed Scopus (17) Google Scholar Extrathoracic symptoms, such as vomiting, stomach pain, dysphagia, vertigo and fainting, are occasionally described in the literature.8Gentina T. Tillie-Leblond I. Birolleau S. et al.Fire-eater’s lung: seventeen cases and a review of the literature.Medicine (Baltimore). 2001; 80: 291-297Crossref PubMed Scopus (49) Google Scholar The presence of hypertrophic osteoarthropathy has been reported in a five-year-old child with a history of forced feeding with animal fat (ghee).41Hugosson C. Bahabri S. Rifai A. Al-Dalaan A. Hipertrophic oteoarthropathy caused by lipoid pneumonia.Pediatr Radiol. 1995; 25: 482-483Crossref PubMed Scopus (3) Google Scholar Since its clinical and radiological presentations are nonspecific, lipoid pneumonia may mimic many other diseases,14Bandla H.P. Davis S.H. Hopkins N.E. Lipoid pneumonia: a silent complication of mineral oil aspiration.Pediatrics. 1999; 103: E19Crossref PubMed Scopus (95) Google Scholar especially bacterial pneumonia, presenting with fever and cough.19Fernández A.A. Díez J.M. Vime R.L. Santos D.G. Botello L.N. Chinarro B.J. Neumonía lipoidea em relación com exposición laboral a pinturas.Arch Bronconeumol. 2003; 39: 133-135Crossref PubMed Google Scholar Occasionally, it can also simulate lung tumours,42Bréchot J.M. Buy J.N. Laaban J.P. Rochemaure J. Computed tomography and magnetic resonance findings in lipoid pneumonia.Thorax. 1991; 46: 738-739Crossref PubMed Scopus (31) Google Scholar pulmonary tuberculosis or cystic fibrosis43Balakrishnan S. Lipoid pneumonia in infants and children in South India.Brit Med J. 1973; 4: 329-331Crossref PubMed Scopus (33) Google Scholar. The diagnosis of exogenous lipoid pneumonia is based on a history of exposure to oil with radiological findings in keeping with the disease and the presence of lipid-laden macrophages on sputum or bronchoalveolar lavage (BAL) analysis.3Gondouin A. Manzoni P.H. Ranfaing E. et al.Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France.Eur Respir J. 1996; 9: 1463-1469Crossref PubMed Scopus (189) Google Scholar, 28Lee K.H. Kim W.S. Cheon J.E. Seo J.B. Kim I.O. Yeon K.M. Squalene aspiration pneumonia in children: radiographic and CT findings as the first clue to diagnosis.Pediatr Radiol. 2005; 35: 619-623Crossref PubMed Scopus (17) Google Scholar It should be considered, however, that none of these findings alone is diagnostic of lipoid pneumonia. Exogenous lipoid pneumonias may be difficult to diagnose because a history of oil ingestion is often missed. The exposure is often identified only retrospectively after the diagnosis is made, when a directed history is" @default.
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