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Nayir Buyuksahin H, Kiper N. Childhood Interstitial Lung Disease. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2023; 36:5-15. [PMID: 36695653 DOI: 10.1089/ped.2022.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Childhood interstitial lung disease (chILD) is a heterogeneous group of diseases with various clinical and imaging findings. The incidence and prevalence have increased in recent years, probably due to better comprehension of these rare diseases and increased awareness among physicians. chILDs present with nonspecific pulmonary symptoms, such as tachypnea, hypoxemia, cough, rales, and failure to thrive. Unnecessary invasive procedures can be avoided if specific mutations are detected through genetic examinations or if typical imaging patterns are recognized on computed tomography. Disease knowledge and targeted therapies are improving through international collaboration. Pulmonary involvement in systemic diseases is not uncommon. Pulmonary involvement may be the first finding in connective tissue diseases. This review aims to present a systematic patient-targeted approach to the diagnosis of chILD.
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Affiliation(s)
- Halime Nayir Buyuksahin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
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2
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Quan MA, Hoerger JL, Mullins EH, Kuhn BT. A 66-Year-Old Man With Subacute Cough and Worsening Dyspnea Previously Diagnosed With COVID-19 Pneumonia. J Investig Med High Impact Case Rep 2022; 10:23247096211055334. [PMID: 35001693 PMCID: PMC8753074 DOI: 10.1177/23247096211055334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 66-year-old man presented with subacute cough and worsening dyspnea. Labs were notable for moderate peripheral eosinophilia, and computed tomography (CT) scan demonstrated extensive crazy-paving throughout bilateral upper lung fields. Bronchoalveolar lavage (BAL) revealed macrophages with lipid-filled vacuoles and negative periodic acid-Schiff (PAS) stain. Further history obtained from the patient and family was notable for daily application of commercially available vapor rub to nares and intentional deep inhalation of nebulized fluids containing scented oils. The patient was diagnosed with exogenous lipoid pneumonia through an unusual route of lipid administration.
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Affiliation(s)
- Michelle A Quan
- University of California Davis School of Medicine, Sacramento, USA
| | - Joshua L Hoerger
- University of California Davis School of Medicine, Sacramento, USA.,VA Northern California Health Care System, Mather, CA, USA
| | | | - Brooks T Kuhn
- University of California Davis School of Medicine, Sacramento, USA.,VA Northern California Health Care System, Mather, CA, USA
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3
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Shang L, Gu X, Du S, Wang Y, Cao B, Wang C. The efficacy and safety of therapeutic lung lavage for exogenous lipoid pneumonia: A systematic review. CLINICAL RESPIRATORY JOURNAL 2021; 15:134-146. [PMID: 32940399 DOI: 10.1111/crj.13273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 08/11/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES Exogenous lipoid pneumonia (ELP) is a lung inflammatory disease with low prevalence and has the feature of external lipid substances presented in the alveoli. Therapeutic lung lavage (segmental bronchoalveolar lavage and whole lung lavage) has been gradually recognized as an important therapy for the disease. There was no comprehensive summary on its efficacy and safety. METHODS We searched PubMed, Embase, Cochrane Library, CNKI, Wanfang Database, clinicaltrials.gov, and the references of included studies. After study selection, data extraction and quality assessment, we performed a qualitative description of current data. RESULTS We included 90 ELP patients from 25 case reports and 8 case series studies. Eighty-four (93.3%) patients received segmental bronchoalveolar lavage and six (6.7%) patients received whole lung lavage. Eighty-seven (96.7%) patients got clinical improvement after lavages, while three (3.3%) patients had no improvement and eventually died. The follow-up status was reported in 29 patients, of whom 24 patients remained well without any use of drugs and 4 patients remained well with some periods of corticosteroids. One patient endured recurrence. The radiological change was reported in 72 patients, of whom 41 (56.9%) patients had full resolution until the last follow-up. Two studies reported acute pulmonary edema and transient hypoxemia during lavages. CONCLUSIONS Therapeutic lung lavage might be an effective and safe therapy with long-term benefits for ELP. Current studies were all case reports and case series with relatively high risk of bias. Prospective controlled studies are needed to explore the actual efficacy, safety, individualized indications, and optimized treatment procedures of therapeutic lung lavage for ELP.
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Affiliation(s)
- Lianhan Shang
- Beijing University of Chinese Medicine, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoying Gu
- Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Sisi Du
- Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Yimin Wang
- Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Department of Respiratory Medicine, Capital Medical University, Beijing, China.,Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Department of Respiratory Medicine, Capital Medical University, Beijing, China.,Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China.,Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center for Respiratory Diseases, National Clinical Research Center for Respiratory Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Clinical Center for Pulmonary Infections, Capital Medical University, Beijing, China.,Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China.,Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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4
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Marangu D, Gray D, Vanker A, Zampoli M. Exogenous lipoid pneumonia in children: A systematic review. Paediatr Respir Rev 2020; 33:45-51. [PMID: 30962152 PMCID: PMC7106224 DOI: 10.1016/j.prrv.2019.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/08/2018] [Accepted: 01/16/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To describe the clinical-radiological-pathological characteristics and treatment outcomes of children with suspected exogenous lipoid pneumonia (ELP). DESIGN Systematic review. We searched electronic databases and reference lists published between 1967 and 2018, restricted to non-accidental cases. RESULTS Forty-four studies including 489 participants aged 1 day to 17 years from 13 countries were included. Cultural, medical, and behavioural rationale for oil-use was described. The clinical-radiological presentation varied widely. Diagnostic certainty was deemed highest if ELP was confirmed on bronchoalveolar lavage/frozen section lung biopsy with documented extracellular lipid on cytological staining and/or fat analysis. Non-tuberculous mycobacteria infection was identified in six studies: Mycobacterium fortuitum/chelonei, Mycobacterium smegmatis and Mycobacterium abscessus. Treatment comprised supportive therapy, corticosteroids, stopping oil, therapeutic lung-lavage and surgical resection. Outcomes were reported inconsistently. CONCLUSION Paediatric ELP resulting from cultural and medical practices continues to be described globally. Preventive interventions, standardized reporting, and treatment efficacy studies for cases not averted, are lacking. Protocol registration: PROSPERO CRD42017068313.
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Affiliation(s)
- Diana Marangu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya; Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
| | - Diane Gray
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Aneesa Vanker
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Marco Zampoli
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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5
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Seong GM, Kim M. Exogenous lipoid pneumonia presented by acute eosinophilic pneumonia. ALLERGY ASTHMA & RESPIRATORY DISEASE 2019. [DOI: 10.4168/aard.2019.7.1.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Gil Myeong Seong
- Departments of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Miok Kim
- Departments of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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Marangu D, Pillay K, Banderker E, Gray D, Vanker A, Zampoli M. Exogenous lipoid pneumonia: an important cause of interstitial lung disease in infants. Respirol Case Rep 2018; 6:e00356. [PMID: 30094029 PMCID: PMC6079933 DOI: 10.1002/rcr2.356] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/29/2018] [Accepted: 07/13/2018] [Indexed: 11/10/2022] Open
Abstract
Exogenous lipoid pneumonia (ELP), an important cause of interstitial lung disease, often goes unrecognized. We conducted a retrospective study of children with histologically confirmed ELP at Red Cross Children's Hospital, South Africa. Twelve children of Zimbabwean heritage aged 2.1-10.8 months were identified between 2012 and 2017. Repeated oral administration of plant-based oil for cultural reasons was reported by 10 of 11 caregivers. Cough (12/12), tachypnoea (11/12), hypoxia (9/12), and diffuse alveolar infiltrates on chest radiography (12/12) were common at presentation. Chest computed tomography revealed ground-glass opacification with lower zone predominance (9/9) and interlobular septal thickening (8/9). Bronchoalveolar lavage specimens appeared cloudy/milky, with abundant lipid-laden macrophages and extracellular lipid on Oil-Red-O staining (12/12), with polymicrobial (6/12) and Mycobacterium abscessus (2/12) co-infection. Antibiotics, systemic corticosteroids, and therapeutic lavage were interventions in all eight and five patients, respectively. Clinicians should consider ELP in children with non-resolving pneumonia in settings with similar practices.
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Affiliation(s)
- Diana Marangu
- Department of Paediatrics and Child HealthUniversity of NairobiNairobiKenya
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - Komala Pillay
- Division of Pathology, Department of Paediatrics and Child HealthUniversity of Cape TownCape TownSouth Africa
| | - Ebrahim Banderker
- Division of Radiology, Department of Paediatrics and Child HealthUniversity of Cape TownCape TownSouth Africa
| | - Diane Gray
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - Aneesa Vanker
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
| | - Marco Zampoli
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent HealthUniversity of Cape TownCape TownSouth Africa
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Sodhi KS, Sharma M, Lee EY, Saxena AK, Mathew JL, Singh M, Khandelwal N. Diagnostic Utility of 3T Lung MRI in Children with Interstitial Lung Disease: A Prospective Pilot Study. Acad Radiol 2018; 25:380-386. [PMID: 29239833 DOI: 10.1016/j.acra.2017.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/01/2017] [Accepted: 09/21/2017] [Indexed: 12/25/2022]
Abstract
RATIONALE AND OBJECTIVES The objective of this study was to assess the diagnostic utility of 3-tesla (3T) magnetic resonance imaging (MRI) of lungs in the detection of interstitial lung disease (ILD) in pediatric patients. MATERIALS AND METHODS Twelve children (mean: 8.5 years, range: 4-12 years) with ILD were consecutively enrolled in this prospective study. HRCT and 3T lung MRI were performed in all patients within 2 days of each other. The sensitivity, the specificity, the positive predictive value, and the negative predictive value of detecting lung abnormalities related to ILD with 3T lung MRI were calculated, with high-resolution computed tomography (HRCT) as a standard of reference. Agreement between HRCT and 3T lung MRI, as well as between two reviewers, was calculated with the kappa coefficient. RESULTS 3T lung MRI had low sensitivity (66.67%) and high specificity (97.33%) in the detection of abnormalities related to ILD when compared to HRCT in children. Although 3T lung MRI performed well in the detection of consolidation, parenchymal bands and fissural thickening with a sensitivity of 100%, the sensitivity of 3T lung MRI in the detection of septal thickening, ground-glass opacity, nodules, and cysts was relatively low (50.0%, 50.0%, 66.67%, and 25.0%, respectively). Substantial agreement was seen between HRCT and 3T lung MRI (k = 0.7), whereas perfect agreement was seen between two reviewers in detecting abnormalities related to pediatric ILD (k = 0.9-1.0). CONCLUSIONS In comparison to HRCT, 3T lung MRI with routinely available MRI protocols and sequences can also well detect abnormalities such as consolidation, parenchymal bands, and fissural thickening in children with ILD. However, evaluation of septal thickening, ground-glass opacity, nodules, and cysts is limited with 3T lung MRI.
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Affiliation(s)
- Kushaljit Singh Sodhi
- Department of Radiodiagnosis and Imaging, PGIMER, Sector-12, Chandigarh, 160012, India.
| | - Madhurima Sharma
- Department of Radiodiagnosis and Imaging, PGIMER, Sector-12, Chandigarh, 160012, India
| | - Edward Y Lee
- Departments of Radiology and Medicine, Pulmonary Division, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Akshay Kumar Saxena
- Department of Radiodiagnosis and Imaging, PGIMER, Sector-12, Chandigarh, 160012, India
| | | | - Meenu Singh
- Department of Pediatrics, PGIMER, Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, PGIMER, Sector-12, Chandigarh, 160012, India
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Eber E, Antón-Pacheco JL, de Blic J, Doull I, Faro A, Nenna R, Nicolai T, Pohunek P, Priftis KN, Serio P, Coleman C, Masefield S, Tonia T, Midulla F. ERS statement: interventional bronchoscopy in children. Eur Respir J 2017; 50:50/6/1700901. [DOI: 10.1183/13993003.00901-2017] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/08/2017] [Indexed: 12/25/2022]
Abstract
Paediatric airway endoscopy is accepted as a diagnostic and therapeutic procedure, with an expanding number of indications and applications in children. The aim of this European Respiratory Society task force was to produce a statement on interventional bronchoscopy in children, describing the evidence available at present and current clinical practice, and identifying areas deserving further investigation. The multidisciplinary task force panel performed a systematic review of the literature, focusing on whole lung lavage, transbronchial and endobronchial biopsy, transbronchial needle aspiration with endobronchial ultrasound, foreign body extraction, balloon dilation and occlusion, laser-assisted procedures, usage of airway stents, microdebriders, cryotherapy, endoscopic intubation, application of drugs and other liquids, and caregiver perspectives. There is a scarcity of published evidence in this field, and in many cases the task force had to resort to the collective clinical experience of the committee to develop this statement. The highlighted gaps in knowledge underline the need for further research and serve as a call to paediatric bronchoscopists to work together in multicentre collaborations, for the benefit of children with airway disorders.
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9
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Serrano-Falcón B, Rey E. The safety of available treatments for chronic constipation. Expert Opin Drug Saf 2017; 16:1243-1253. [DOI: 10.1080/14740338.2017.1361402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Blanca Serrano-Falcón
- Department of Digestive Diseases, Hospital Clinico San Carlos, Complutense University, Instituto de Investigacion Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Enrique Rey
- Department of Digestive Diseases, Hospital Clinico San Carlos, Complutense University, Instituto de Investigacion Sanitaria San Carlos (IdISSC), Madrid, Spain
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Hayman YA, Sadofsky LR, Williamson JD, Hart SP, Morice AH. The effects of exogenous lipid on THP-1 cells: an in vitro model of airway aspiration? ERJ Open Res 2017; 3:00026-2016. [PMID: 28344981 PMCID: PMC5358527 DOI: 10.1183/23120541.00026-2016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 01/14/2017] [Indexed: 12/14/2022] Open
Abstract
Chronic inflammatory diseases of the airways are associated with gastro-oesophageal reflux (GOR) and aspiration events. The observation of lipid-laden macrophages (LLMs) within the airway may indicate aspiration secondary to GOR. The proposed mechanism, that lipid droplets from undigested or partially digested food are aspirated leading to accumulation in scavenging macrophages, led us to hypothesise that an activated population of LLMs could interact with other immune cells to induce bronchial inflammation. To test this, we generated an in vitro model using differentiated THP-1 cells, which were treated with a high-fat liquid feed. Here, we show that THP-1 cells can take up lipid from the high-fat feed independent of actin polymerisation or CD36-dependent phagocytosis. These cells did not exhibit M1 or M2 polarisation. Gene array analysis confirmed over 8000 genes were upregulated by at least twofold following high fat exposure, and IL-8 was the most upregulated gene. Pathway analysis revealed upregulation of genes known to be involved in chronic obstructive pulmonary disease (COPD) pathophysiology. We suggest that aspiration and macrophage phagocytosis may be important mechanisms in the aetiology of diseases such as COPD and cystic fibrosis that are characterised by high levels of IL-8 within the airways.
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Affiliation(s)
| | - Laura R. Sadofsky
- Centre for Cardiovascular and Metabolic Research, Hull York Medical School, University of Hull, Hull , UK
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Rahaghi F, Varasteh A, Memarpour R, Tashtoush B. Teppanyaki/Hibachi Pneumonitis: An Exotic Cause of Exogenous Lipoid Pneumonia. Case Rep Pulmonol 2016; 2016:1035601. [PMID: 27965910 PMCID: PMC5124667 DOI: 10.1155/2016/1035601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 10/25/2016] [Indexed: 01/15/2023] Open
Abstract
Exogenous lipoid pneumonia (ELP) is a rare type of inflammatory lung disease caused by aspiration and/or inhalation of fatty substances and characterized by a chronic foreign body-type reaction to intra-alveolar lipid deposits. The usual clinical presentation occurs with insidious onset of nonspecific respiratory symptoms and radiographic findings that can mimic other pulmonary diseases. Diagnosis of ELP is often missed or delayed as it requires a high index of suspicion and familiarity with the constellation of appropriate history and radiologic and pathologic features. We herein report a case of occupational exposure to tabletop "Teppanyaki" entertainment cooking as a cause of ELP, confirmed by surgical lung biopsies in a 63-year-old Asian woman who worked as a Hibachi-Teppanyaki chef for 25 years.
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Affiliation(s)
- Franck Rahaghi
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA
| | - Ali Varasteh
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA
| | - Roya Memarpour
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA
| | - Basheer Tashtoush
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL 33331, USA
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Hotta T, Tsubata Y, Okimoto T, Hoshino T, Hamaguchi S, Isobe T. Exogenous lipoid pneumonia caused by herbicide inhalation. Respirol Case Rep 2016; 4:e00172. [PMID: 27516888 PMCID: PMC4970308 DOI: 10.1002/rcr2.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/15/2016] [Accepted: 05/19/2016] [Indexed: 11/07/2022] Open
Abstract
Exogenous lipoid pneumonia is caused by aspiration or inhalation of oily substances. Generally, lipoid pneumonia has non‐specific clinical and radiological presentations and may be misdiagnosed as bacterial pneumonia. Our patient, a 68‐year‐old man who had been diagnosed with pneumonia on three previous occasions, was admitted to our hospital with a fourth similar episode. Computed tomography of the chest revealed extensive consolidations with air bronchograms in lung fields on the right side. The bronchoalveolar lavage fluid (BALF) increased ghost‐like macrophages that stained positive for lipid. Our patient reported that he had sprayed herbicide in large quantities without wearing a mask. We analysed the BALF and herbicide by gas chromatography and diagnosed exogenous lipoid pneumonia caused by inhalation of herbicide. Clinicians should be aware of lipoid pneumonia, which may present as infectious pneumonia.
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Affiliation(s)
- Takamasa Hotta
- Department of Internal Medicine, Division of Clinical Oncology and Respiratory MedicineShimane University Faculty of MedicineShimaneJapan
| | - Yukari Tsubata
- Department of Internal Medicine, Division of Clinical Oncology and Respiratory MedicineShimane University Faculty of MedicineShimaneJapan
| | - Tamio Okimoto
- Department of Internal Medicine, Division of Clinical Oncology and Respiratory MedicineShimane University Faculty of MedicineShimaneJapan
| | - Teppei Hoshino
- Department of Internal Medicine, Division of Clinical Oncology and Respiratory MedicineShimane University Faculty of MedicineShimaneJapan
| | - Shun‐ichi Hamaguchi
- Department of Internal Medicine, Division of Clinical Oncology and Respiratory MedicineShimane University Faculty of MedicineShimaneJapan
| | - Takeshi Isobe
- Department of Internal Medicine, Division of Clinical Oncology and Respiratory MedicineShimane University Faculty of MedicineShimaneJapan
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Han C, Liu L, Du S, Mei J, Huang L, Chen M, Lei Y, Qian J, Luo J, Zhang M. Investigation of rare chronic lipoid pneumonia associated with occupational exposure to paraffin aerosol. J Occup Health 2016; 58:482-488. [PMID: 27488044 PMCID: PMC5356983 DOI: 10.1539/joh.16-0096-cs] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objectives: Occupational exposure to paraffin is an infrequent cause of lipoid pneumonia (LP) and related data are scare. We investigated the possible relationship between three rare cases of chronic LP and occupational exposure to paraffin aerosol in an iron foundry. Methods: The three cases of LP and their workplaces were investigated using data from field investigations, air monitoring, pulmonary radiological examinations, cell staining, and lung biopsies. Results: The patients had long-term occupational exposure to paraffin. X-ray diffraction testing revealed that the raw material from the workshop was paraffin crystal. The air concentrations of paraffin aerosol in workplaces were significantly higher than outdoor background levels. Small diffuse and miliary shadows with unclear edges were observed throughout the whole lungs via radiography. Computed tomography revealed diffuse punctate nodules and a high density of stripe-like shadows in both lungs (ground-glass opacity in a lower lobe, and a mass-like lesion and high translucent area near the bottom of the lung). Lipid-laden macrophages were found in the sputum and bronchial lavage. A broadened alveolar septum and local focal fibrosis were also discovered via lung biopsy. The inflammatory reaction in the lung tissues appeared to resolve over time. Conclusions: These three rare cases of chronic LP in workers during molding and repair processes were associated with occupational paraffin aerosol exposure. Therefore, primary prevention is essential for molding or repairing workers in the iron foundry, and a differential diagnosis of occupational chronic LP (vs. pneumoconiosis) should be considered when treating these workers.
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Faro A, Wood RE, Schechter MS, Leong AB, Wittkugel E, Abode K, Chmiel JF, Daines C, Davis S, Eber E, Huddleston C, Kilbaugh T, Kurland G, Midulla F, Molter D, Montgomery GS, Retsch-Bogart G, Rutter MJ, Visner G, Walczak SA, Ferkol TW, Michelson PH. Official American Thoracic Society Technical Standards: Flexible Airway Endoscopy in Children. Am J Respir Crit Care Med 2015; 191:1066-80. [DOI: 10.1164/rccm.201503-0474st] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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15
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Simões MCRDS, Toro IFC, Ribeiro JD, Toro AADC. Pneumonia lipoide em lactente de 40 dias de vida. J Bras Pneumol 2012; 38:535-7. [DOI: 10.1590/s1806-37132012000400019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Barron HW, Rosenthal KL. Respiratory Diseases. FERRETS, RABBITS, AND RODENTS 2012. [PMCID: PMC7152247 DOI: 10.1016/b978-1-4160-6621-7.00006-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Chronic constipation is a very common problem in the paediatric population, and a particularly frequent issue in the management of neurologically impaired children. The use of mineral oil in the treatment of constipation has been well accepted because of its efficacy and infrequent side effects. The case of a three and a half-year-old girl with spastic quadriplegic cerebral palsy, who was admitted to hospital for investigation of increasing tachypnea and respiratory distress over a two-month period, is presented. This case highlights lipoid pneumonia due to mineral oil aspiration, which is a recognized severe complication of this medication, and emphasizes the need for a heightened awareness among caregivers about the potential dangers of inappropriate mineral oil use.
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Affiliation(s)
- M Weinstein
- Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario
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18
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Exogenous lipoid pneumonia. Clinical and radiological manifestations. Respir Med 2011; 105:659-66. [DOI: 10.1016/j.rmed.2010.12.001] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 11/28/2010] [Accepted: 12/01/2010] [Indexed: 11/23/2022]
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Clement A, Nathan N, Epaud R, Fauroux B, Corvol H. Interstitial lung diseases in children. Orphanet J Rare Dis 2010; 5:22. [PMID: 20727133 PMCID: PMC2939531 DOI: 10.1186/1750-1172-5-22] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 08/20/2010] [Indexed: 12/30/2022] Open
Abstract
Interstitial lung disease (ILD) in infants and children comprises a large spectrum of rare respiratory disorders that are mostly chronic and associated with high morbidity and mortality. These disorders are characterized by inflammatory and fibrotic changes that affect alveolar walls. Typical features of ILD include dyspnea, diffuse infiltrates on chest radiographs, and abnormal pulmonary function tests with restrictive ventilatory defect and/or impaired gas exchange. Many pathological situations can impair gas exchange and, therefore, may contribute to progressive lung damage and ILD. Consequently, diagnosis approach needs to be structured with a clinical evaluation requiring a careful history paying attention to exposures and systemic diseases. Several classifications for ILD have been proposed but none is entirely satisfactory especially in children. The present article reviews current concepts of pathophysiological mechanisms, etiology and diagnostic approaches, as well as therapeutic strategies. The following diagnostic grouping is used to discuss the various causes of pediatric ILD: 1) exposure-related ILD; 2) systemic disease-associated ILD; 3) alveolar structure disorder-associated ILD; and 4) ILD specific to infancy. Therapeutic options include mainly anti-inflammatory, immunosuppressive, and/or anti-fibrotic drugs. The outcome is highly variable with a mortality rate around 15%. An overall favorable response to corticosteroid therapy is observed in around 50% of cases, often associated with sequelae such as limited exercise tolerance or the need for long-term oxygen therapy.
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Affiliation(s)
- Annick Clement
- Pediatric Pulmonary Department, Reference Center for Rare Lung Diseases, AP-HP, Hôpital Trousseau, Inserm UMR S-938, Université Pierre et Marie Curie-Paris 6, Paris, F-75012 France.
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20
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Sias SMDA, Ferreira AS, Daltro PA, Caetano RL, Moreira JDS, Quirico-Santos T. Evolução da pneumonia lipoide exógena em crianças: aspectos clínicos e radiológicos e o papel da lavagem broncoalveolar. J Bras Pneumol 2009; 35:839-45. [DOI: 10.1590/s1806-37132009000900004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 05/05/2009] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever os aspectos da evolução da pneumonia lipoide em crianças, com base em aspectos clínicos, radiológicos e de achados no lavado broncoalveolar, enfatizando a importância diagnóstica e terapêutica da lavagem broncoalveolar. MÉTODOS: Foram incluídas 28 crianças, com idade média de 20 meses (1-108 meses) e diagnóstico de pneumonia crônica refratária a antimicrobianos e/ou TB. A maioria apresentava um fator de risco para aspiração, e todas apresentavam história de ingestão de óleo mineral para o tratamento de constipação intestinal (23/28) ou de ascaridíase complicada (5/28). A avaliação clínica e tomográfica e análises do lavado broncoalveolar foram realizadas no início do tratamento e em até 24 meses. RESULTADOS: Os sintomas mais frequentes foram taquipneia e tosse. As principais alterações radiológicas foram consolidações (23/28), infiltrado peri-hilar (13/28) e hiperinsuflação (11/28). A TC de tórax mostrou consolidações com broncograma aéreo (24/28), diminuição de atenuação nas áreas de consolidação (16/28), opacidade em vidro fosco (3/28) e padrão em mosaico (1/28). O estudo do lavado broncoalveolar apresentava macrófagos espumosos corados por Sudan, confirmando o diagnóstico da pneumonia lipoide. Após tratamento com múltiplas lavagens broncoalveolares (média = 9,6), 20 crianças tornaram-se assintomáticas, havendo normalização tomográfica em 18. CONCLUSÕES: O diagnóstico de pneumonia lipoide deve ser considerado na pneumonia crônica ou TB refratárias ao tratamento, especialmente se houver história de ingestão de óleo mineral. A broncoscopia com múltiplas lavagens broncoalveolares mostrou-se eficiente para a depuração do óleo aspirado do parênquima pulmonar e a prevenção da fibrose, contribuindo para a redução da morbidade dessa doença, que ainda é pouco diagnosticada.
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Sias SMA, Daltro PA, Marchiori E, Ferreira AS, Caetano RL, Silva CS, Müller NL, Moreira J, Quirico-Santos T. Clinic and radiological improvement of lipoid pneumonia with multiple bronchoalveolar lavages. Pediatr Pulmonol 2009; 44:309-15. [PMID: 19283836 DOI: 10.1002/ppul.20918] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To assess the potential role of multiple bronchoalveolar lavages (BALs) in the treatment of children with lipoid pneumonia (LP). MATERIALS AND METHODS This prospective study included 10 children (7 female, 3 male) with LP secondary to mineral oil aspiration. The age ranged from 3 months to 7 years and 1-60 days history of mineral oil intake, with a 6 months clinic follow-up. High-resolution computer tomography (CT) was performed 1-7 days prior to treatment and 2-20 days after the last therapeutic BAL, and reviewed by two experienced chest radiologists. Oxygen saturation was measured with digital oximetry. Therapeutic BAL was performed weekly until BAL fluid was nearly transparent and the cell count returned to normal range values. RESULTS In all children, the initial CT scans showed multifocal bilateral consolidation involving mainly the dorsal and central regions. The areas of consolidation had foci of decreased attenuation in eight patients. Following a total of 4-10 therapeutic BALs, the CT scans returned to normal in 3 patients, improved considerably in 5, and showed only slight improvement in 2. Oxygen saturation increased from 88.8 +/- 3.4% at presentation to 96.2 +/- 0.8% after treatment (P < 0.0001). Multiple lavages reduced (P < 0.003) numbers of lipid-laden macrophages and restored BAL cellularity to normal range values. CONCLUSION Multiple therapeutic BAL of children with LP results in significant improvement of CT findings, oxygen saturation, restoration of BAL fluid cellularity and clinical recover without any evidence of respiratory distress at the end of treatment and 6 months after the last BAL.
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Affiliation(s)
- Selma M A Sias
- Department of Pediatrics, Hospital Universitario Antonio Pedro, Fluminense Federal University, Rio de Janeiro, Brazil.
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Marchiori E, Zanetti G, Escuissato DL, Souza Jr. AS, Araújo Neto C, Nobre LF, Irion KL, Rodrigues R, Mançano AD, Capone D, Fialho SM, Souza CA. Pneumonia lipoídica em adultos: aspectos na tomografia computadorizada de alta resolução. Radiol Bras 2007. [DOI: 10.1590/s0100-39842007000500007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Apresentar os aspectos na tomografia computadorizada de alta resolução do tórax da pneumonia lipoídica exógena por aspiração de óleo mineral, em pacientes adultos MATERIAIS E MÉTODOS: Foram estudados oito pacientes adultos - quatro mulheres e quatro homens - com média de idade de 69,4 anos, todos usuários de óleo mineral para tratamento de constipação intestinal. Os exames foram avaliados por dois radiologistas, de forma independente RESULTADOS: Os achados tomográficos mais comuns foram as consolidações com áreas de densidade de gordura de permeio, e o padrão de pavimentação em mosaico. As lesões foram bilaterais em seis pacientes, e unilaterais em dois CONCLUSÃO: O encontro de consolidações pulmonares com áreas de densidade de gordura de permeio, associado à história clínica do uso de óleo mineral, é diagnóstico de pneumonia lipoídica exógena.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Domenico Capone
- Universidade Federal do Rio de Janeiro, Brasil; Universidade Estadual do Rio de Janeiro
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Israel-Biet D, Danel C. [Contribution of bronchoalveolar lavage to the management of interstitial lung disease]. REVUE DE PNEUMOLOGIE CLINIQUE 2005; 61:141-8. [PMID: 16142186 DOI: 10.1016/s0761-8417(05)84805-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Bronchoalveolar lavage (BAL) is a minimally invasive method for exploring the distal lung. It enables collection of free cellular and acellular material present in the alveoli. Over the last two decades BAL has become a fundamental tool for positive diagnosis of interstitial lung disease and even more for differential diagnosis. It has contributed greatly to the diagnosis of lung infections, particularly in immunosuppressed patients. In the context of non-infectious infiltrative disease, the diagnostic contribution of BAL is limited due to the lack of a specific cell profile. It remains a fundamental tool for the differential diagnosis of idiopathic interstitial pneumonia. With BAL, a number of infectious or tumoral diseases can be ruled out with precision. It is also an important element for the evaluation of possible iatrogenic disease. BAL has transformed the diagnosis of interstitial lung disease and considerably reduced the indications for surgical biopsy.
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Affiliation(s)
- Dominique Israel-Biet
- Service de Pneumologie, Hôpital Européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, Faculté de Médecine Paris-5.
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Terzano C, Ricci A, Petroianni A, Laurendi G, Mammarella A, Paoletti V, Marziali M, De Luca N. Lipoid pneumonia in multiple sclerosis: an insidious complication--case report. Adv Ther 2003; 20:138-42. [PMID: 12956255 DOI: 10.1007/bf02850200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Claudio Terzano
- Department of Cardiovascular and Respiratory Sciences, University La Sapienza, Rome, Italy
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