Images in Clinical Medicine

Exogenous Lipoid Pneumonia

Benjamin W. Berg, M.D., and Jeff S. Saenger, M.D.

N Engl J Med 1998; 338:512February 19, 1998

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Figure 1 A 68-year-old nonsmoking woman was evaluated because of progressive dyspnea and chronic lung disease. She had had middle lobe syndrome for 20 years. She had been taking 2 to 3 teaspoons (10 to 15 ml) of mineral oil at bedtime since early childhood. A posteroanterior radiograph of the chest showed bilateral alveolar infiltrates in the bases, volume loss, and middle-lobe consolidation (Panel A). Tests of lung function revealed restrictive and obstructive defects. Bronchoalveolar lavage was performed, and the differential count revealed 46 percent macrophages, 37 percent lymphocytes, 13 percent neutrophils, and 4 percent eosinophils. Stains and cultures were negative. Exogenous lipoid pneumonia was diagnosed on the basis of microscopical analysis of cytospin preparations of bronchoalveolar lavage fluid. Panel B shows a large alveolar macrophage with numerous confluent red-staining cytoplasmic vacuoles filled with lipid (oil red O stain, ×320). Panel C shows numerous alveolar macrophages with multiple heterogeneous clear vacuoles (Papanicolaou's stain, ×128). Panel D shows a transmission electron micrograph of an alveolar macrophage with multiple membrane-bound vacuoles with scalloped borders (×3450). No therapy was instituted, but the patient stopped taking mineral oil. There were no clinically significant changes in symptoms or radiographic findings four years later, and the lung deficits are not expected to improve.

Benjamin W. Berg, M.D.
Jeff S. Saenger, M.D.
Tripler Army Medical Center, Honolulu, HI 96859-5000

Citing Articles (5)

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   Sylvia Guendelman, Megan Wier, Veronica Angulo, Doug Oman. (2006) The Effects of Child-Only Insurance Coverage and Family Coverage on Health Care Access and Use: Recent Findings among Low-Income Children in California. Health Services Research 41:1, 125-147
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   Shira E. Baron, Linda B. Haramati, Vivian T. Rivera. (2003) Radiological and Clinical Findings in Acute and Chronic Exogenous Lipoid Pneumonia. Journal of Thoracic Imaging 18:4, 217-224
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   S. Nogue, P. Sanz, J. C. Borondo, M. Picon, G. de la Red, G. Mestre. (2003) Fatal lipoid pneumonia due to bronco-aspiration of isoparaffin after ingestion of an organophosphate insecticide. Acta Anaesthesiologica Scandinavica 47:6, 777-779
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5. 5

   (1998) A Risk of Mineral Oil. New England Journal of Medicine 339:26, 1947-1948
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