title: Lipoid pneumonia: a challenging diagnosis.
abstract: Lipoid pneumonia is a rare medical condition, and is usually classified into two groups, ie, exogenous or endogenous, depending on the source of lipids found in the lungs. Exogenous lipoid pneumonia may result from the aspiration of food and lipids. Although most cases are asymptomatic, common symptoms include cough, dyspnea, chest pain, pleural effusions, fever, and hemoptysis. Radiologically, lipoid pneumonia can manifest as consolidations, pulmonary nodules, or soft-tissue densities. These presentations involve a wide differential diagnosis, including lung cancer. Other rare causes of fatty pulmonary lesions include hamartomas, lipomas, and liposarcomas. The avoidance of further exposures and the use of corticosteroids, antibiotics, and lavage comprise the mainstays of treatment. The exclusion of mycobacterial infections is important during diagnosis, in view of their known association. Generally, acute presentations run a benign course, if promptly treated. Chronic cases are more persistent and difficult to treat. Although the radiologic and pathologic diagnosis is fairly reliable, more research is needed to clarify the optimal treatment and expected outcomes. We report on a 54-year-old man presenting with progressively worsening cough, hemoptysis, and dyspnea over a few weeks. The patient underwent multiple computed tomographies of the chest and bronchoscopies. All failed to diagnose lipoid pneumonia. The diagnosis was finally established using video-assisted thoracoscopic surgery. Most of the paraffinoma was resected during this surgery. He was treated with antibiotics and steroids, and discharged from the hospital in stable condition.
authors.affiliation: Department of Medicine, Staten Island University Hospital, Staten Island, New York 10305, USA. kassemharris@gmail.com
authors.forename: Kassem
authors.initials: K
authors.lastname: Harris
authors.forename: Michel
authors.initials: M
authors.lastname: Chalhoub
authors.forename: Rabih
authors.initials: R
authors.lastname: Maroun
authors.forename: Francois
authors.initials: F
authors.lastname: Abi-Fadel
authors.forename: Fan
authors.initials: F
authors.lastname: Zhao
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018893:Bronchoalveolar Lavage; D004802:Eosinophilia; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011017:Pneumonia, Lipid / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone