Clinical and radiological manifestations of lipoid pneumonia according to etiology: Squalene, omega‐3‐acid ethyl esters, and idiopathic

Cha, Seung‐Ick; Choi, Sun Ha; Kim, Hyun Jung; Kim, Yeon Jae; Lim, Jae‐Kwang; Yoo, Seung Soo; Lee, Shin-Yup; Lee, Jaehee; Kim, Chang‐Ho; Park, Jae Yong

doi:10.1111/crj.13015

Cited by 9 publications

(14 citation statements)

References 30 publications

(61 reference statements)

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“…It has been established that inhaling various oils and high-molecular-mass lipophilic compounds causes this condition. Repeated or extended inhalation and pulmonary exposure to substances including mineral oil, squalene, Vaseline, olive oil, castor oil, omega-3-acid esters, rendered animal fat, and amiodarone are known to cause lipoid pneumonia [33][34][35][36][37][38][39]. Given that VEA is also a high-molecular-mass, semi-volatile and lipophilic oil with similar chemical and physical properties (logP oct/water >6 and boiling point >200 • C at 760 mmHg) as compounds that are known cause lipoid pneumonia, it is possible that VEA is causative or contributes to the development of EVALI and lipoid pneumonia.…”

Section: Vaping and Pulmonary Diseasementioning

confidence: 99%

Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent

Duffy

et al. 2020

Toxics

114

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Beginning in June of 2019, there was a marked increase in reported cases of serious pulmonary injury associated with vaping. The condition, referred to as e-cigarette or vaping product use-associated lung injury (EVALI), does not appear to involve an infectious agent; rather, a chemical adulterant or contaminant in vaping fluids is suspected. In August of 2019, the Wadsworth Center began receiving vaporizer cartridges recovered from patients with EVALI for analysis. Having no a priori information of what might be in the cartridges, we employed untargeted analyses using gas chromatography-mass spectrometry and high-resolution mass spectrometry to identify components of concern. Additionally, we employed targeted analyses used for New York medical marijuana products. Here, we report on the analyses of 38 samples from the first 10 New York cases of EVALI for which we obtained cartridges. The illicit fluids had relatively low cannabinoid content, sometimes with unusual Δ9-/Δ8-tetrahydrocannabinol ratios, sometimes containing pesticides and many containing diluents. A notable diluent was α-tocopheryl acetate (vitamin E acetate; VEA), which was found in 64% of the cannabinoid-containing fluids. To investigate potential sources of the VEA, we analyzed six commercial cannabis-oil diluents/thickeners. Three were found to be >95% VEA, two were found to be primarily squalane, and one was primarily α-bisabolol. The cause(s) of EVALI is unknown. VEA and squalane are components of some personal care products; however, there is growing concern that vaping large amounts of these compounds is not safe.

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Section: Vaping and Pulmonary Diseasementioning

confidence: 99%

Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent

Duffy

et al. 2020

Toxics

114

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“…These results do not preclude harm caused by vaping EVPs that contain SQA and SQE. Aspirated SQE has been shown to cause lipoid pneumonia ( Kanaji et al, 2008 ; Kim et al, 2009 ; Cha et al, 2018 ) and has been detected in EVP aerosol emissions ( Cowan et al, 2022 ). Thus, more research is needed to understand the health consequences of chronically inhaling these chemicals as constituents of EVP-produced aerosol.…”

Section: Application Resultsmentioning

confidence: 99%

“…In an urgent attempt to identify the cause of the outbreak-associated lung injury, bronchoalveolar lavage (BAL) fluid samples from case patients were analyzed by the Centers for Disease Control and Prevention (CDC) for multiple EVP-associated chemicals ( DeJesús et al, 2020a ; DeJesús et al, 2020b ; Holder et al, 2021 ; Morel-Espinosa et al, 2021 ; Xia et al, 2021 ; Brosius et al, 2022 ). Limited clinical observations indicate that SQE can cause lipoid pneumonia following accidental inhalation, and thus SQE and SQA were considered potential substances of interest ( Lee et al, 1999 ; Kanaji et al, 2008 ; Cha et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

The Quantitation of Squalene and Squalane in Bronchoalveolar Lavage Fluid Using Gas Chromatography Mass Spectrometry

et al. 2022

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Chemicals of unknown inhalational toxicity are present in electronic cigarette and vaping products. E-cigarettes typically contain nicotine and other relatively hydrophilic chemicals while vaping products typically contain cannabinoids and other hydrophobic chemicals. For example, vaping products can include hydrophobic terpenes such as squalane (SQA) and squalene (SQE). However, little is known about the SQA and SQE transmission from liquid to aerosol. SQA and SQE are used in commercial products that are applied dermally and ingested orally, but limited information is available on their inhalational exposure and toxicity. We developed and validated a quantitative method to measure SQE and SQA in bronchoalveolar lavage fluid to assess if these chemicals accumulate in lung epithelial lining fluid after inhalation. Calibration curves spanned a range of 0.50–30.0 µg analyte per mL bronchoalveolar lavage fluid. Recoveries were found to be 97–105% for SQE and 81–106% for SQA. Limits of detection were 0.50 μg/ml for both SQE and SQA. The method was applied to bronchoalveolar lavage fluid samples of patients from the 2019 outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI) and a comparison group. Neither SQA nor SQE was detected above the method LOD for any samples analyzed; conversely, SQA or SQE were reproducibly measured in spiked quality control BAL fluids (relative standards deviations <15% for both analytes). Further applications of this method may help to evaluate the potential toxicity of SQA and SQE chronically inhaled from EVPs.

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“…CXR may even be normal. CECT chest patterns described are airspace consolidations, ground glass opacities, crazy paving pattern, interlobular septal thickening, and mass-like lesions [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Shine like gold and sparkle like glitter: Three cases of lipoid pneumonia

Acharya

Dsouza

Sreeram

et al. 2021

Respiratory Medicine Case Reports

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Lipoid pneumonia (LP) is an unwonted, mostly asymptomatic entity which has no classical radiological appearance. It can be endogenous or exogenous depending upon the type of exposure or underlying milieu. It simulates a number of infective and malignant respiratory conditions and can go undiagnosed or delayed leading to morbidity and mortality. We put forward three cases that initially presented as classical pneumonia, but on further assessment and investigations were diagnosed to be LP. All the three cases manifested with symptoms of fever, productive cough and breathlessness. Chest Xray and CT scan were indicative of consolidation. Bronchoalveolar lavage (BAL) evinced lipid laden macrophages that stained positive with fat stains (Sudan IV and Oil Red O). Two cases were endogenous and one was exogenous type. LP, owing to its nonspecific clinical presentation and radiographic signs, needs a high index of suspicion, and a detailed clinical history for accurate diagnosis. Corroboration of lipid laden alveolar macrophages in BAL is the crux to the diagnosis. Hence, clinicians should be cognizant of this condition and rule out LP in cases of non-resolving pneumonia in an appropriate clinical context.

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Clinical and radiological manifestations of lipoid pneumonia according to etiology: Squalene, omega‐3‐acid ethyl esters, and idiopathic

Cited by 9 publications

References 30 publications

Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent

Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent

The Quantitation of Squalene and Squalane in Bronchoalveolar Lavage Fluid Using Gas Chromatography Mass Spectrometry

Shine like gold and sparkle like glitter: Three cases of lipoid pneumonia

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