Am Fam Physician. 1998 Dec 1;58(9):2093-2094.
A 74-year-old man presented for admission to a long-term care facility. A chest radiograph revealed a right middle lobe density that had not changed in five years (see the accompanying radiograph). The patient was afebrile and had an occasional dry cough. Bronchoscopy was unremarkable; cultures for acid-fast bacilli and fungi were negative, and cytology was significant only for “foamy macrophages.” The patient's medical history was significant for gastroesophageal reflux, hypertension, congestive heart failure and chronic constipation. Current medications included digoxin (Lanoxin), diltiazem (Cardizem) and daily oral mineral oil.
Which one of the following is the correct diagnosis given the patient's history and radiographic findings?
A. Primary lung tumor.
C. Lipoid pneumonia.
D. Lung abscess.
E. Metastatic carcinoma.
The answer is C: lipoid pneumonia. Exogenous lipoid pneumonia is a rare inflammatory reaction resulting from chronic aspiration of oil or fat. It is most commonly associated with the use of oral mineral oil, and nose drops that contain paraffin. It has also been reported to occur following injection of oils.1 The most common symptom of lipoid pneumonia is chronic cough; however, the disease is often discovered incidentally on a routine chest radiograph.2 Radiographic findings include either a multilobar consolidating infiltrate or a well-circumscribed homogenous infiltrate in a lower lobe,3 as is seen in this patient's radiograph. Computed tomography may demonstrate a mass with decreased attenuation.4 The diagnosis is confirmed by obtaining sputum or bronchial washings containing lipid-laden alveolar macrophages. Treatment includes the immediate cessation of the oil product.3
Of the remaining multiple choice answers, the smooth border and solitary nature of this lesion are more suggestive of a primary lung tumor than of metastatic carcinoma. However, both the chronicity and the bronchoscopic findings effectively eliminate these diagnoses. A lesion associated with postprimary or reactivation tuberculosis is most often seen in the apical lobes. Lung abscess typically causes a cavitary lesion with an air-fluid level. The absence of either a fever or a productive cough makes this diagnosis unlikely.
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Navy Medical Department or the Naval Service at large.
REFERENCESshow all references
1. Bhagat R, Holmes I, Kulaga A, Murphy F, Cockcroft DW. Self-injection with olive oil. A cause of lipoid pneumonia. Chest. 1995;107:875–6....
2. Davies SF, Ingram RH. Focal and multifocal lung disease. In: Scientific American medicine. New York: Scientific American, 14;IV-3.
3. Baum GL, Wolinsky E, eds. Embolic infections of the lungs. In: Textbook of pulmonary diseases. 5th ed. Boston: Little, Brown, 1994:586–91.
4. Lee KS, Muller NL, Hale V, Newell JD Jr, Lynch DA, Im JG. Lipoid pneumonia: CT findings. J Comput Assist Tomogr. 1995;19:48–51.
Contributing editor is MARC S. BERGER, M.D., C.M.
The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at http://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. E-mail submissions to email@example.com.
Copyright © 1998 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions
More in AFP
MOST RECENT ISSUE
Sep 15, 2017
Access the latest issue of American Family Physician