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Electron Microscopic Findings in BAL of a Fire-eater After Petroleum Aspiration*

Olaf Burkhardt; Hans-Joachim Merker; Mehdi Shakibaei; Hartmut Lode
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*From the Department of Chest and Infectious Diseases (Dr. Burkhardt and Professor Lode), Hospital Heckeshorn; and the Institute of Anatomy (Professors Merker and Shakibaei), University Hospital Benjamin Franklin, Free University Berlin, Berlin, Germany.

Correspondence to: Hartmut Lode, MD, Department of Chest and Infectious Diseases, Chest Hospital Heckeshorn, Zum Heckeshorn 33, D-14109 Berlin, Germany; e-mail: haloheck@zedat.fu-berlin.de



Chest. 2003;124(1):398-400. doi:10.1378/chest.124.1.398
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Hydrocarbon pneumonitis, known also as fire-eater pneumonia, always develops after aspiration of low-viscosity, volatile hydrocarbides. Despite the presence of clear-cut indicators for an infection, it is considered to be an acute pseudoinfectious lung disease. In this article, we report on a relatively rare clinical picture of a 30-year-old man after accidental petroleum aspiration. In addition to the usual clinical and instrumental examinations, we also performed, for the first time, electron microscopic investigations of the BAL specimen. A striking finding was the occurrence of macrophages (40%) with numerous lipoid inclusions that exhibited all morphologic signs of an activation as well as neutrophil granulocytes (33%), lymphocytes (21%), and eosinophils (6%). Despite a large and necrotizing infiltration of the right lower lobe, the clinical course was uneventful with complete recovery.

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