title: Exogenous lipoid pneumonia induced by nasal decongestant.
abstract: BACKGROUND
  Lipoid pneumonia is a clinical condition that may be initially asymptomatic or confused with an infectious or malignant lung disease.
  
  
  OBJECTIVE
  We report four cases of this pathological condition.
  
  
  METHODS
  The first case concerned an 85-year old woman with bilateral confluent pulmonary opacities, ground-glass type. Diagnosis was based on the cytology of the bronchoalveolar lavage (BAL) fluid followed by its ultrastructural examination. The second case was a 47-year-old man with an isolated pulmonary nodule, which was surgically removed; the diagnosis of lipoid pneumonia was formulated on the basis of the histological and electron microscopy examination. The third case concerned a 73-year-old woman, with bilateral hypodense areas at the bases of the lungs where FDG PET/CT scan showed an increased uptake. Diagnosis was formulated by BAL cytology and electron microscopy examination. The fourth case was a 69-year-old man, who performed a virtual colonoscopy for diverticulosis putting in evidence a round mass (3 cm in diameter) with two small peripheral nodules, located in the pulmonary left lower lobe. The histopathological examination of transthoracic biopsy confirmed a lipoid pneumonia.
  
  
  CONCLUSIONS
  In all four cases, it was put in evidence a prolonged use of a nasal decongestant containing mineral oils. In literature, the most cases described are characterized by a subclinical evolution and were presented as ground glass opacities which evolve, in the later phases, in an interstitial involvement or in a peripheral mass, simulating a lung tumour.
authors.affiliation: Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy.
authors.forename: Giorgia A
authors.initials: GA
authors.lastname: Osman
authors.affiliation: Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ricci
authors.affiliation: Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Terzo
authors.affiliation: UOD Cytopathology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Falasca
authors.affiliation: UOD Cytopathology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy.
authors.forename: Maria R
authors.initials: MR
authors.lastname: Giovagnoli
authors.affiliation: Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy.
authors.forename: Pierdonato
authors.initials: P
authors.lastname: Bruno
authors.affiliation: Division of Pathology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vecchione
authors.affiliation: UO of Cellular Diagnostics, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Raffa
authors.affiliation: UO of Cellular Diagnostics, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy.
authors.forename: Sabatino
authors.initials: S
authors.lastname: Valente
authors.affiliation: UO of Cellular Diagnostics, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy.
authors.forename: Maria R
authors.initials: MR
authors.lastname: Torrisi
authors.affiliation: UO of Radiology, AOU Sant'Andrea, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: De Dominicis
authors.affiliation: Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy.
authors.forename: Simonetta
authors.initials: S
authors.lastname: Giovagnoli
authors.affiliation: Division of Pneumology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, AOU Sant'Andrea, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Mariotta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018893:Bronchoalveolar Lavage / Q000379:methods; D003113:Colonoscopy / Q000379:methods; D043963:Diverticulosis, Colonic / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008899:Mineral Oil / Q000009:adverse effects; D014663:Nasal Decongestants / Q000009:adverse effects*; D011017:Pneumonia, Lipid / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D000072078:Positron Emission Tomography Computed Tomography; D003074:Solitary Pulmonary Nodule / Q000473:pathology* / Q000601:surgery / Q000648:ultrastructure; D014057:Tomography, X-Ray Computed
chemical_list: D014663:Nasal Decongestants; D008899:Mineral Oil
keywords: bronchoalveolar lavage; chest CT scan; electron microscopic examination; foamy macrophages; lipoid pneumonia