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Exogenous lipoid pneumonia: when radiologist makes the difference.

Diletta Cozzi1, Alessandra Bindi2, Edoardo Cavigli2

  • 1Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy. dilettacozzi@gmail.com.

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|May 27, 2020
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Summary
This summary is machine-generated.

High-resolution CT (HRCT) reveals characteristic patterns in exogenous lipoid pneumonia (ELP), aiding diagnosis. Key findings include adipose density consolidations and crazy-paving patterns, crucial for differentiating ELP from other lung diseases.

Keywords:
Computed tomographyHRCTLungPneumonia

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Area of Science:

  • Radiology
  • Pulmonology
  • Pathology

Background:

  • Exogenous lipoid pneumonia (ELP) is a rare lung disease caused by chronic aspiration of lipid-containing substances.
  • Accurate diagnosis relies on a combination of clinical history, imaging, and sometimes histopathology.

Purpose of the Study:

  • To detail the high-resolution CT (HRCT) findings in patients with histopathologically confirmed exogenous lipoid pneumonia (ELP).
  • To identify common radiological patterns associated with ELP for improved diagnostic accuracy.

Main Methods:

  • Retrospective analysis of HRCT scans from 10 patients diagnosed with ELP.
  • Radiological evaluation by three radiologists.
  • Diagnosis confirmed by CT, bronchoalveolar lavage (BAL), pneumological examination, clinical history, and lung biopsy in five patients.
  • All patients had a history of chronic exposure to animal fats or mineral/vegetable oils.

Main Results:

  • Common HRCT findings included lung consolidation with adipose density (< -40 HU) in 80% of patients.
  • Ground glass opacities were present in all 10 patients.
  • The "crazy-paving" pattern (interlobular septal thickening with ground glass opacities) was observed in 60% of patients.
  • Tumor-like nodules (>2.5 cm with spiculated margins) were seen in 20% of patients.
  • Reactive lymphadenopathy was present in 50% of patients.
  • Older lesions showed bronchiectasis and fibrosis.

Conclusions:

  • HRCT findings in ELP can mimic other lung diseases, including lung tumors, posing a diagnostic challenge.
  • Consolidation areas with low Hounsfield Unit (HU) values and the "crazy-paving" pattern are frequent indicators of ELP.
  • Radiologists should consider ELP in the differential diagnosis when these patterns are observed, correlating with clinical and anamnestic data.