Monday, September 27, 2010

Exogenous and Endogenous Lipoid Pneumonia

Lipoid pneumonia can be classified as either exogenous or endogenous based on the source of the lipid.

Exogenous lipoid pneumonia occurs with aspiration or inhalation of oils. The classic clinical scenario is one of prolonged laxative ingestion or use of oil-based nose drops. Less common causes include accidental aspiration in children, ingestion in fire eaters, and chronic use of lubricants such as vaporub and lip gloss. Chronic inhalation of oils can also occur in certain occupations, such as those involved in the lubrication and cleaning of machinery and the spraying of pesticides or paints.

Endogenous lipoid pneumonia (cholesterol pneumonia, golden pneumonia), is classically caused by obstruction, resulting in consolidation with accumulation of lipid-filled macrophages and eosinophilic proteinaceous material (e.g., surfactant) from degenerating cells.

Non-obstructive processes may also result in endogenous lipoid pneumonia. These include fungal infections, pulmonary alveolar proteinosis, and lipid-storage disorders (e.g., Niemann-Pick disease).

References

Betancourt SL, Martinez-Jimenez S, Rossi SE, Truong MT, Carrillo J, Erasmus JJ. Lipoid pneumonia: spectrum of clinical and radiologic manifestations. AJR Am J Roentgenol. 2010 Jan;194(1):103-9.

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