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• W4387248276 abstract "SESSION TITLE: Diffuse Lung Disease Case Report Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Lipoid pneumonia is a pathologic process caused by the accumulation of lipids in the lung parenchyma from exogenous or endogenous sources. We present a case of exogenous lipoid pneumonia (ELP) secondary to chronic mineral oil ingestion at bedtime presenting with mass-like lesions and patchy ground-glass opacities in the lungs. CASE PRESENTATION: A 75-year-old man, ex-smoker, with a history of esophageal cancer and an Ivor-Lewis esophagectomy in the year before, presented to the Pulmonary Clinic for evaluation of abnormal chest CT findings. He had been experiencing exertional dyspnea for the preceding six months. Additionally, he described intermittent coughing and choking episodes more frequently at night. He had a history of chronic constipation and regularly ingested mineral oil before bedtime. His chest CT scan showed two mass-like consolidative opacities with low attenuation and a nodule, along with inter- and intralobular septal thickening and ground glass opacities bilaterally. Right hilar lymphadenopathy was also noted. Spirometry revealed airflow obstruction with FEV1 of 46% of predicted and reduced diffusion capacity (52% of predicted). Transthoracic needle aspiration biopsy of the right lower lobe lung nodule showed chronic inflammation and findings of exogenous lipoid pneumonia. A video swallow evaluation was negative for overt aspiration but revealed barium reflux in the recumbent position. Discontinuation of mineral oil was advised, and lifestyle modifications to avoid further reflux-aspiration events were implemented. On follow-up, there was improvement on pulmonary function tests and symptoms. DISCUSSION: Chronic ELP results from inhalation or aspiration of lipid-containing substances into the lungs that trigger an inflammatory response. The most common culprit is ingestion of various oils. Radiologically, it can present with areas of low-attenuation infiltrates, ground glass and consolidative opacities, as well as crazy-paving pattern. Of note, fat attenuation is not always appreciable. In this case, there was coexistence of fat attenuation lesions and identifiable exposure pointing to exogenous lipoid pneumonia as the most likely diagnosis, although given the prior history of malignancy and a mass-like lesion, malignancy was also a possibility. The mainstay of treatment for ELP is avoidance of inciting agents and recurrent aspiration. CONCLUSIONS: Exogenous lipoid pneumonia should be considered in the differential diagnosis of chronic or recurrent pulmonary opacities, particularly in the presence of low-attenuation lesions. Appropriate history should be obtained to identify potential exposure to inhaled or ingested oil sources. REFERENCE #1: Marchiori E, Zanetti G, Mano CM, Hochhegger B. Exogenous lipoid pneumonia. Clinical and radiological manifestations. Respir Med. 2011 May;105(5):659-66. doi: 10.1016/j.rmed.2010.12.001. Epub 2010 Dec 23. PMID: 21185165. REFERENCE #2: Samhouri BF, Tandon YK, Hartman TE, Harada Y, Sekiguchi H, Yi ES, Ryu JH. Presenting Clinicoradiologic Features, Causes, and Clinical Course of Exogenous Lipoid Pneumonia in Adults. Chest. 2021 Aug;160(2):624-632. doi: 10.1016/j.chest.2021.02.037. Epub 2021 Feb 26. PMID: 33647249. REFERENCE #3: Betancourt SL, Martinez-Jimenez S, Rossi SE, Truong MT, Carrillo J, Erasmus JJ. Lipoid pneumonia: spectrum of clinical and radiologic manifestations. AJR Am J Roentgenol. 2010 Jan;194(1):103-9. doi: 10.2214/AJR.09.3040. PMID: 20028911. DISCLOSURES: No relevant relationships by Amarilys Alarcon-Calderon No relevant relationships by Jay Ryu" @default.
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• W4387248276 date "2023-10-01" @default.
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• W4387248276 title "MASS-LIKE OPACITIES IN THE LUNG AFTER IVOR-LEWIS ESOPHAGECTOMY DUE TO EXOGENOUS LIPOID PNEUMONIA" @default.
• W4387248276 doi "https://doi.org/10.1016/j.chest.2023.07.2090" @default.
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