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Exogenous lipoid pneumonia: when radiologist makes the difference

  • CHEST RADIOLOGY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

To report high-resolution CT (HRCT) findings in our group of patients with exogenous lipoid pneumonia (ELP), confirmed with histopathological findings and clinical-anamnestic data, in order to describe the most common radiological patterns of this rare disorder.

Materials and methods

In this retrospective study, HRCT of 10 patients with ELP were evaluated by three radiologists. Diagnosis of ELP was made through CT, bronchiolo-alveolar lavage (BAL) and a pneumological examination associated with an accurate medical anamnesis. Five patients had a histologically proven ELP, through lung biopsy. All patients had a chronic exposition to substances made of animal fat or mineral/vegetable oils.

Results

In our cohort of patients with ELP, the following parenchymal patterns were observed: 8/10 patients had lung consolidation with adipose density (attenuation values < − 40 HU); 10/10 patients had multiple areas of ground glass opacity; 6/10 patients had smooth thickening of interlobular septa and ground glass opacities (“crazy-paving” pattern); 2/10 patients presented nodules > 2.5 cm with spiculated margins (tumor-like); 5/10 patients showed reactive lymph nodes enlargement. The oldest lesions were characterized by bronchiectasis and fibrosis around the lipidic consolidations.

Conclusion

Pulmonary alterations found in HRCT exams can be confused with other lung diseases (especially lung tumors) and they are always a challenge even for the most experienced radiologist. In our experience, although non-specific, consolidation areas with low HU values and crazy-paving pattern are frequently associated in ELP. These characteristics should alert the radiologist to consider ELP among the possible differential diagnoses, always correlating the results of CT examination with appropriate clinical-laboratory evaluations and an accurate anamnesis.

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Authors and Affiliations

  1. Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy

    Diletta Cozzi, Alessandra Bindi, Edoardo Cavigli, Silvia Luvarà, Noemi Morelli, Chiara Moroni & Vittorio Miele

  2. Unit of Pneumology and Thoracic-Pulmonary Physiopathology, Careggi University Hospital, Florence, Italy

    Anna Maria Grosso

  3. Department of Interventional Pneumology, Careggi University Hospital, Florence, Italy

    Rosamaria Piperio

  4. Department of Radiology, Santo Stefano Hospital, Prato, Italy

    Maurizio Bartolucci

Authors
  1. Diletta Cozzi
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  2. Alessandra Bindi
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  3. Edoardo Cavigli
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  4. Anna Maria Grosso
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  5. Silvia Luvarà
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  6. Noemi Morelli
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  7. Chiara Moroni
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  8. Rosamaria Piperio
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  9. Vittorio Miele
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  10. Maurizio Bartolucci
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Corresponding author

Correspondence to Diletta Cozzi.

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The authors declare that they have no conflict of interest related to the publication of this article.

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All procedures performed in studies involvement human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Cozzi, D., Bindi, A., Cavigli, E. et al. Exogenous lipoid pneumonia: when radiologist makes the difference. Radiol med 126, 22–28 (2021). https://doi.org/10.1007/s11547-020-01230-x

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  • DOI: https://doi.org/10.1007/s11547-020-01230-x

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