The efficacy and safety of therapeutic lung lavage for exogenous lipoid pneumonia: A systematic review

Lipoid Pneumonia Following Chronic Aspiration of Cannabis Oil Used for the Treatment of Seizures

CASE PRESENTATION

A 4-year-old girl with ring chromosome 14, epilepsy, global developmental delay, and failure to thrive presented for a preoperative assessment for gastrostomy tube (G-tube) insertion and was incidentally found to be hypoxemic, with saturations of 81% in room air. There was no history of fever or upper respiratory tract infection symptoms; however, her parents described a progressive history of choking and emesis with feeds over 3 months. Chest radiograph demonstrated patchy alveolar opacities in the right lower and middle lobes. She was admitted to the hospital and treated with supplemental oxygen and IV ampicillin for a suspected aspiration pneumonia. On day 3 of her admission, because of persistent hypoxemia despite high-flow nasal cannula support at 2 L/kg/min with an Fio2 of 0.6 to 0.7, and frequent need for suctioning of thick yellow secretions, she was transferred to the PICU for escalation to noninvasive ventilation. Because of poor response after 7 days, and respiratory secretions showing moderate growth of Klebsiella oxytoca and light growth of Stenotrophomonas maltophilia, sulfamethoxazole-trimethoprim was added. Azithromycin was also started on day 8 to cover atypical pathogens, then discontinued when Mycoplasma pneumoniae polymerase chain reaction was negative.

Unmasking the mimic: lipoid pneumonia imitating primary lung cancer - a case report series of a diagnostic challenge

Introduction

Lipoid pneumonia is a rare inflammatory disease characterized by an abnormal deposition of lipids in the alveoli. It may manifest as pulmonary consolidation, simulating primary lung cancer on radiological imaging and an increased uptake on fluorine-18-fluorodeoxy-D-glucose (FDG) positron-emission tomography (PET)/computed tomography (CT). The confirmed diagnosis can be achieved only by microscopic examination of cytological or histological samples.

Methods

This paper describes eight cases at a single center from 2016 to 2024 of lipoid pneumonia mimicking primary lung cancer and its risk factors. Samples were collected thanks to multidisciplinary evaluations using CT and FDG-PET/CT. The histopathological diagnoses were obtained with endobronchial ultrasound (EBUS), fine needle aspiration biopsy (FNAB), or, as a last resort, surgical resection.

Results

Our cohort of patients confirms that lung masses with fat density and irregular margins are lipoid pneumonia's most common findings. However, it can also present as a solid mass with no fat density. This condition must always be appropriately evaluated through a multidisciplinary approach, especially when excluding a neoplastic origin.

Conclusion

In this paper, we present the largest case series of lipoid pneumonia mimicking primary lung cancer from a single center reported in the literature so far. This case series highlighted the critical role of a multidisciplinary approach, including radiologists and pathologists, in differentiating lipoid pneumonia from malignancy to ensure optimal patient management.

Relevance of superoxide dismutase type 1 to lipoid pneumonia: the first retrospective case-control study

BACKGROUND

Lipoid pneumonia (LP) is a rare disease caused by the accumulation of lipids and lipid-laden macrophages in the alveoli inducing damage. LP is difficult to differentiate from other similar diseases without pathological evidence, such as upper respiratory tract infection (URTI), pneumonia, cryptogenic organizing pneumonia (COP), pulmonary alveolar proteinosis (PAP), lung mucinous adenocarcinoma and pulmonary edema. Given the high misdiagnosis rate and limited statistical clinical and treatment data, there is an urgent need for novel indicators of LP. Superoxide dismutase type1 (SOD1) plays an essential role in macrophage polarization, promoting inflammation and oxidative stress, but its association with LP remains unknown.

METHODS

The clinical data of 22 patients with proven LP from January 2008 to June 2024 and their prognostic information up to June 2024 were retrospectively gathered (ClinicalTrials.gov, NCT06430008). Additionally, information on patients with URTI, bacterial and fungal pneumonia, COP, PAP, lung mucinous adenocarcinoma and pulmonary edema, was collected totaling 140 patients as control subjects. Receiver operating characteristic curve, machine learning (ML), regression and survival analyses were performed to analyze the data.

RESULTS

In multivariate regression analysis, the sole independent risk factor of LP was the level of SOD1 (OR 0.922, 95% CI: 0.878 ~ 0.967, P < 0.001), while smoking status (β= -0.177, 95% CI -18.645~-2.836, P = 0.008), diabetes mellitus (β= -0.191, 95% CI: -20.442~-3.592, P = 0.005), and total sialic acid (TSA) (β= -0.426, 95% CI: -0.915~ -0.433, P < 0.001) independently influenced the level of SOD1. SOD1 had the highest importance score in ML-based LP predictive models. Additionally, advanced age may be associated with higher mortality in LP.

CONCLUSION

SOD1 is a potential biomarker for LP, but the smoking status, diabetes comorbidities, and TSA level need to be considered.

The effect of therapeutic bronchoalveolar lavage in combination with glucocorticoids on children with acute exogenous lipoid pneumonia

BACKGROUND

Exogenous lipoid pneumonia (ELP) is a rare disease caused by the inhalation of oily materials in the alveoli with the pathological characterization by the presence of laden-lipid macrophages in the respiratory specimens. At present, the treatment norm for ELP has not well defined, and so the aim of this study is to evaluate the effect of bronchoalveolar lavage in combination with glucocorticoids on children with ELP.

METHODS AND MATERIALS

We retrospectively reviewed 17 children with a confirmed history of exogenous oily materials aspiration, admitted to the First Affiliated Hospital of Guangzhou Medical University from June 2012 to December 2021. Clinical features, blood investigations, tomographic evaluations, therapeutic bronchoalveolar lavage and glucocorticoids use were carried out at the beginning of therapy and throughout a follow-up period.

RESULTS

The included children are the median age of 2 years. Fever, dypnea and tachypnea were the most common symptoms. The most common radiological features were airspace consolidations (15, 93.75%). Chest CT scans showed areas of consolidation with air bronchogram (15, 93.75%), poorly defined centrilobular nodules (13, 81.25%), areas of ground-glass attenuation (11, 68.75%) and 'crazy-paving' pattern (6, 37.5%) in the both lower, right middle lung lobes. Neutrophil percentage of peripheral blood and bronchoalveolar lavage fluid exhibited a significantly higher than the normal range. After treatment with multiple bronchoalveolar lavages and local administration of budesonide during the hospital stay, taken by oral prednisolone (1 ~ 2 mg/kg) after discharge, all of children became asymptomatic and presented normal radiological imagings in the follow-up period.

CONCLUSION

The most frequently findings in the CT scan of ELP were consolidations and ground-glass attenuation in the both lower and right middle lung lobes. Multiple bronchoalveolar lavages in combination with oral prednisolone for children who had a confirmed history of exogenous oily substances ingestion were an efficient and safe for the clearance of oily materials from the lung and the prevention of fibrosis. This strategy contributed to reducing the damage of ELP in children patients.