Bronchoalveolar Lavage in Liquid Paraffin Pneumonitis

Lauque, D.; Dongay, G; Levade, Thierry; Caratero, C; Carlès, Pierre

doi:10.1378/chest.98.5.1149

Cited by 49 publications

(43 citation statements)

References 17 publications

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“…The macroscopic appearance of BAL with fat globules on the fluid surface and the cytologic demonstration of lipid-laden macrophages 14 is consistent with the diagnosis of ELP. Kameswaran et al 15 reported a series of 24 cases of lipoid pneumonia in children, 22 of which were diagnosed by rigid bronchoscopy with BAL.…”

supporting

confidence: 71%

Lipoid Pneumonia: A Silent Complication of Mineral Oil Aspiration

1999

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ABSTRACT. Introduction. Chronic constipation is a common symptom in pediatrics, and physicians often use mineral oil to treat chronic constipation in children. Mineral oil, a hydrocarbon, may not elicit a normal protective cough reflex and may impair mucociliary transport. These effects can increase the likelihood of its aspiration and subsequent impaired clearance from the respiratory tract. We report a case of a child with neurodevelopmental delay with chronic constipation and a history of chronic mineral oil ingestion presenting as asymptomatic exogenous lipoid pneumonia (ELP).Case History. A 6-year-old white boy with a history of developmental delay was found to have an infiltrate in his right upper lobe on a chest radiograph obtained during evaluation for thoracic scoliosis. The patient had a long history of constipation with daily use of mineral oil. He was fed by mouth and had occasional episodes of coughing and choking during feeding. He was asymptomatic at presentation and physical examination was unremarkable. The patient was advised to stop administration of the mineral oil and was treated empirically with antibiotics during a 3-month period. At follow-up examination the patient continued to be asymptomatic, with the radiologic persistence of the infiltrate. Diagnosis of lipoid pneumonia was made by diagnostic bronchoscopy with bronchoalveolar lavage (BAL). The exogenous origin of the lipid in the BAL fluid was confirmed by gas chromatography/mass spectrometry.Discussion. The clinical presentation of ELP is nonspecific and ranges from the totally asymptomatic patient with incidental radiologic finding, like our patient, to the patient with acute or chronic symptoms attributable to pneumonia, pulmonary fibrosis, or cor pulmonale. Bronchoscopy with BAL can be successful in establishing the diagnosis of ELP by demonstration of a high lipid-laden macrophage index. Treatment of ELP in children is generally supportive, with the symptoms and roentgenographic abnormalities resolving within months after stopping the use of mineral oil.Conclusion. Lipoid pneumonia as a result of mineral oil aspiration still occurs in the pediatric population. It can mimic other diseases because of its nonspecific clinical presentation and radiographic signs. In patients with swallowing dysfunction and pneumonia, a history of mineral oil use should be obtained and a diagnosis of ELP should be considered in the differential diagnoses if mineral oil use has occurred. Our case points to the need for increased awareness by the general pediatricians of the potential hazards of mineral oil use for chronic constipation. Pediatrics 1999;103(2). URL: http://www. pediatrics.org/cgi/content/full/103/2/e19; bronchoalveolar lavage, constipation, exogenous lipoid pneumonia, lipidladen macrophages, mineral oil.ABBREVIATIONS. RUL, right upper lobe; CXR, chest x-ray; BAL, bronchoalveolar lavage; ELP, exogenous lipoid pneumonia. C hronic constipation, a common symptom in pediatrics, accounts for 3% of referrals to teaching hospital clinics and 10...

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confidence: 71%

Lipoid Pneumonia: A Silent Complication of Mineral Oil Aspiration

1999

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“…Cytological analysis showed a high mean cellularity in the present series (324 cells·mm -3 ). CORWIN and IRWIN [21] reported a similar finding on BAL of nine subjects, but LAUQUE et al [22] reported normal cellularity. Various cytological profiles have been described in the literature for isolated cases: macrophage alveolitis [23][24][25]; lymphocytic alveolitis [26][27][28], and neutrophilic alveolitis [22].…”

Section: Discussionmentioning

confidence: 69%

“…CORWIN and IRWIN [21] reported a similar finding on BAL of nine subjects, but LAUQUE et al [22] reported normal cellularity. Various cytological profiles have been described in the literature for isolated cases: macrophage alveolitis [23][24][25]; lymphocytic alveolitis [26][27][28], and neutrophilic alveolitis [22]. Study of the 35 cases submitted to BAL with cytological analysis provides an idea of the frequency of these cytological profiles: normal (31% cases); isolated lymphocytic (23%); isolated neutrophilic (14%); and mixed alveolitis (31%).…”

Section: Discussionmentioning

confidence: 69%

Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France

Gondouin¹,

Ranfaing²,

Brun³

et al. 1996

European Respiratory Journal

206

215

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A nationwide retrospective study of exogenous lipid pneumonia (ELP) was carried out to update the data on this disease, with emphasis on thoracic computed tomography (CT) scan and bronchoalveolar lavage (BAL) findings.The inclusion criteria were: 1) presence of abnormal imaging features compatible with the diagnosis of ELP; 2) presence of intrapulmonary lipids; and 3) exogenous origin of the lipid pneumonia.Forty four cases were included (20 males and 24 females; mean age 62±11 yrs), of which four were occupational (chronic inhalation of cutting mist or oily vapour in an industrial environment). Thirty of the 40 nonoccupational cases were related to aspiration of liquid paraffin used for the treatment of constipation. A condition possibly favouring oil aspiration or inhalation was present in 34 patients (77%), most commonly gastro-oesophageal reflux (n=20) and neurological or psychiatric illness (n=14). Fever (39%), weight loss (34%), cough (64%), dyspnoea (50%) and crepitations (45%) were the most frequent symptoms. BAL was performed in 39 cases: 23% had a lymphocytic alveolitis; 14% neutrophilic alveolitis; and 31% a mixed alveolitis (lymphocytic and neutrophilic). Alveolar consolidations (57%), ground glass opacities (39%), and alveolar nodules (23%) were the most common radiological abnormalities. The changes were bilateral (79%), predominant in the posterior and lower zones of the lobes concerned (74%), hypodense (71%), and spared the subpleural zones (52%). In 13 cases, hypodensity was retrospectively established on CT scan by the presence of a "positive angiogram". This sign may be of diagnostic value when the density measurement is either not possible or not reliable.In conclusion, this study provides an update of the clinical, biological and radiological profile of exogenous lipid pneumonia and, in particular, confirms the diagnostic benefit of computed tomography scan, which revealed bilateral and hypodense changes in a large majority of cases.

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“…Histological examination revealed the presence of lipidladen macrophages, and histochemical lipid staining was useful to differentiate the type of lipids phagocytosed by this patient's AMs (1,5). The results revealed the presence of two types of lipids in the AMs; one was a dominant neutral lipid and the other was a phospholipid.…”

Section: Discussionmentioning

confidence: 79%

Exogenous Lipoid Pneumonia Following Ingestion of Liquid Paraffin.

et al. 2002

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An asymptomatic patient with exogenous lipoid pneumonia (ELP) due to silent aspiration of liquid paraffin ingested as a lubricant was diagnosed by bronchoalveolar lavage (BAL). BAL fluid separated into oily upper phase and lower aqueous phase spontaneously. Microscopic analysis of BAL cells revealed the presence of lipid-laden alveolar macrophages. Classic histochemical staining and electron microscope examination indicated that neutral lipid was dominant but phospholipid was also present in the lipidladen macrophages. Together with the history of ingestion of liquid paraffin, we identified that the ingested liquid paraffin was the origin of the neutral lipid in the lipid-laden macrophages observed in the BAL fluid. (Internal Medicine 41: 483-486, 2002)

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Bronchoalveolar Lavage in Liquid Paraffin Pneumonitis

Cited by 49 publications

References 17 publications

Lipoid Pneumonia: A Silent Complication of Mineral Oil Aspiration

Lipoid Pneumonia: A Silent Complication of Mineral Oil Aspiration

Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France

Exogenous Lipoid Pneumonia Following Ingestion of Liquid Paraffin.

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