Lipoid pneumonia is a specific form of lung inflammation (

pneumonia Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severi ...

) that develops when

lipids Lipids are a broad group of naturally-occurring molecules which includes fats, waxes, sterols, fat-soluble vitamins (such as vitamins A, D, E and K), monoglycerides, diglycerides, phospholipids, and others. The functions of lipids include ...

enter the bronchial tree. The disorder is sometimes called

cholesterol Cholesterol is any of a class of certain organic molecules called lipids. It is a sterol (or modified steroid), a type of lipid. Cholesterol is biosynthesized by all animal cells and is an essential structural component of animal cell mem ...

pneumonia in cases where that lipid is a factor.

Signs and symptoms

The pneumonia presents as a foreign body reaction causing

cough A cough is a sudden expulsion of air through the large breathing passages that can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three ph ...

dyspnea Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing di ...

, and often

fever Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...

Hemoptysis Hemoptysis is the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs. In other words, it is the airway bleeding. This can occur with lung cancer, infections such as tuberculosis, bronchitis, or pneumonia, a ...

has also been reported.

Causes

Sources of such lipids could be either exogenous or endogenous.

Exogenous

From outside the body. For example, inhaled nose drops with an oil base, or accidental inhalation of cosmetic oil.

Amiodarone Amiodarone is an antiarrhythmic medication used to treat and prevent a number of types of cardiac dysrhythmias. This includes ventricular tachycardia (VT), ventricular fibrillation (VF), and wide complex tachycardia, as well as atrial fibril ...

is an anti-arrythmic known to cause this condition. Oil pulling has also been shown to be a cause. Fire breather's pneumonia from the inhalation of hydrocarbon fuel is a specific variant. At risk populations include the elderly, developmentally delayed or persons with

gastroesophageal reflux Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is one of the upper gastrointestinal chronic diseases where stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/ ...

. Switching to water-soluble alternatives may be helpful in some situations.

Tuberculosis

A secondary tuberculosis in humans often begins as a lipid pneumonia. This may be due to high content of

mycolic acid Mycolic acids are long fatty acids found in the cell walls of the Mycolata taxon, a group of bacteria that includes ''Mycobacterium tuberculosis'', the causative agent of the disease tuberculosis. They form the major component of the cell wall of ...

cord factor Cord factor, or trehalose dimycolate, is a glycolipid molecule found in the cell wall of '' Mycobacterium tuberculosis'' and similar species. It is the primary lipid found on the exterior of ''M. tuberculosis'' cells. Cord factor influences the ...

, and Wax-D in the cell wall of ''M. tuberculosis,'' that has long been speculated to be a

virulence factor Virulence factors (preferably known as pathogenicity factors or effectors in plant science) are cellular structures, molecules and regulatory systems that enable microbial pathogens (bacteria, viruses, fungi, and protozoa) to achieve the following ...

of the mycobacteria.

Endogenous

From the body itself, for example, when an airway is obstructed, it is often the case that distal to the obstruction, lipid-laden macrophages and

giant cell A giant cell (also known as multinucleated giant cell, or multinucleate giant cell) is a mass formed by the union of several distinct cells (usually histiocytes), often forming a granuloma. Although there is typically a focus on the pathologica ...

s fill the lumen of the disconnected airspace.

Pathology

The gross appearance of a lipid pneumonia is that in which there is an ill-defined, pale yellow area on the lung. This yellow appearance explains the colloquial term "golden" pneumonia. At the microscopic scale foamy macrophages and giant cells are seen in the airways, and the inflammatory response is visible in the parenchyma.

Diagnosis

Lipid pneumonia, exogenous, chronic Case 203 (6970200736)

In terms of the evaluation of Lipid pneumonia we find the following: *Chest X-ray * CT scan *Arterial blood gas (pH) *

Bronchoscopy Bronchoscopy is an endoscopic technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument (bronchoscope) is inserted into the airways, usually through the nose or mouth, or occasionally through a trac ...

(histological sample)

Management

There are no specific guidelines for the treatment of the disease. Limited evidence suggest that the corticosteroids and possibly intravenous

immunoglobulins An antibody (Ab), also known as an immunoglobulin (Ig), is a large, Y-shaped protein used by the immune system to identify and neutralize foreign objects such as pathogenic bacteria and viruses. The antibody recognizes a unique molecule of the ...

may improve condition but in the case of exogenous type the stopping of the offending agent is the step that should be take first.

Prognosis

Endogenous lipoid pneumonia and non-specific interstitial pneumonitis has been seen prior to the development of

pulmonary alveolar proteinosis Pulmonary alveolar proteinosis (PAP) is a rare lung disorder characterized by an abnormal accumulation of surfactant-derived lipoprotein compounds within the alveoli of the lung. The accumulated substances interfere with the normal gas exchange and ...

in a child.

Epidemiology

Lipid pneumonia has been known to occur in underwater divers after breathing poorly filtered air supplied by a surface compressor lubricated by mineral oil.Kizer KW, Golden JA. Lipoid pneumonitis in a commercial abalone diver. Undersea Biomed Res. 1987 Nov;14(6):545-52. PMID: 3686744.

History

Laughlen first described lipid pneumonia in 1925 with infants that inhaled oil droplets. It is a condition that has been seen as an occupational risk for

commercial diving Commercial diving may be considered an application of professional diving where the diver engages in underwater work for industrial, construction, engineering, maintenance or other commercial purposes which are similar to work done out of the wate ...

operations but documented cases are rare.

References

External links

Gross pathology specimen from the University of Utah
{{pneumonia Pneumonia