Lung Pathology: Fellow Case Report Poster - Lung Pathology |

Spiculated Pulmonary Nodules in a High Risk Patient: An Uncommon Presentation of Lipoid Pneumonia FREE TO VIEW

Muhammad Kashif, MD; Masooma Niazi, MD; Muhammad Adrish, MD
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Bronx Lebanon Hospital Center, Bronx, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):773A. doi:10.1016/j.chest.2016.08.869
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SESSION TITLE: Fellow Case Report Poster - Lung Pathology

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Lipoid pneumonia is a rare medical disorder caused by presence of lipids in the alveoli. We present a case of 65 years old male who presented for the evaluation of lung nodules. Lipoid pneumonia was diagnosed on transbronchial biopsy.

CASE PRESENTATION: 65 years old male patient came for the evaluation of abnormal chest imaging. He was asymptomatic at presentation. His past medical history was significant for chronic obstructive pulmonary disease, schizophrenia, constipation and papillary carcinoma of thyroid for which he had undergone total thyroidectomy. His medications include albuterol, tiotropium bromide, levothyroxine, clozapine and mineral oil laxative. He had 15-pack-years smoking history which he quit 12 years ago. His lung examination revealed normal breath sounds. CT chest showed scattered ground glass opacities with bronchiectasis in left lower lobe and spiculated nodules in the left lower lobe and right middle lobe (Figure 1). A bronchoscopy with bronchoalveolar lavage and transbronchial biopsy of left lower lobe was performed. Lavage revealed neutrophil-predominant aspirate with rare mesothelial cells. Transbronchial biopsy was consistent with lipoid pneumonia (Figure 2). Mineral oil laxatives were discontinued. CT chest after 3 months showed radiographic improvement and the patient remained asymptomatic.

DISCUSSION: Lipoid pneumonia (LP) is classified in two major categories; endogenous or exogenous, based on the source of lipid/oil that enters the respiratory system. Most cases may be asymptomatic at presentation. Chronic exogenous LP frequently manifests as ground-glass or consolidative opacities typically in peribronchial distribution and involving dependent lobes. Interlobular septal thickening leading to crazy-paving pattern and an adipose-containing mass have been described. Pulmonary fibrosis can occur in later stages. LP can have increased uptake on positive emission tomography. Treatment in asymptomatic patients remains controversial, but in symptomatic patients with diffuse pulmonary damage, the use of corticosteroids and immunoglobulin therapies has been reported.

CONCLUSIONS: Lipoid Pneumonia is a challenging diagnosis as clinical presentation and radiographic findings are often nonspecific. Physicians need to have a high clinical suspicion for early identification of the diagnosis in order to prevent the development of irreversible fibrosis.

Reference #1: Chin NK, Hui KP, Sinniah R, Chan TB. Idiopathic lipoid pneumonia in an adult treated with prednisolone. Chest. 1994 Mar;105(3):956-7

DISCLOSURE: The following authors have nothing to disclose: Muhammad Kashif, Masooma Niazi, Muhammad Adrish

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