Lipoid pneumonia

Introduction to lipid pneumonia Lipoid pneumonia is a chronic inflammatory response of the lungs to certain lipids. basic knowledge The proportion of illness: 0.0032% Susceptible people: no special people Mode of infection: non-infectious Complications: pulmonary heart disease

Causes of lipid pneumonia

(1) Causes of the disease

According to different causes of lipid pneumonia, it can be divided into exogenous and endogenous.

Exogenous lipid pneumonia is caused by inhalation of plant, animal or mineral oil. Mineral oil is the most common liquid paraffin. It is a liquid paraffin nasal drop, which often flows into the drooping part of the lungs. It uses liquid paraffin as a laxative. When aspiration is inhaled, the lungs can be inhaled. The mineral oil is less irritating and enters the bronchial tree through the pharynx without causing cough reflexes. It can also hinder the removal of the inhaled oil by the ciliary movement of the airway epithelium.

Mineral oil is an inert substance that is not hydrolyzed in the body. It is rapidly emulsified by the inhaled lungs, swallowed by macrophages, and transported away by lymphatic vessels. If left over, it can cause pulmonary fibrosis. Vegetable oils such as olive oil can be emulsified. But it can not be hydrolyzed by the esterase of the lungs, so it will not damage the lungs, and most of it will be coughed up. The animal oil can be hydrolyzed by the lung esterase to release fatty acids, causing significant inflammation, and early inflammation can exist in the same lesion. And advanced fibrosis.

Infants, debilitated and elderly patients, patients with dysphagia and esophageal diseases, are prone to inhaled lipid pneumonia.

Endogenous lipid pneumonia, also known as cholesterol pneumonia, is a complication of lung cancer, bronchiectasis, radiation therapy and fibrosis secondary to scleroderma or pneumoconiosis. It can also occur in fat embolism, alveolar protein. When there are diseases such as depression and lipid accumulation.

(two) pathogenesis

Lipid-induced pneumonia caused by mineral oil, showing alveolar septal thickening and edema, containing lymphocytes and lipid-rich macrophages, small oil droplets visible in the lymphatic and hilar lymph nodes, showing a large amount of fibrosis, normal lung structure Disappeared, if it is nodular, the lesion is very similar to a tumor, called paraffin.

Cholesterol pneumonia, the appearance of the lung specimen can be seen in gray or yellow appearance, microscopic examination: macrophages containing large amounts of cholesterol can be seen in the alveolar and alveolar walls, the nucleus is located in the center, Sudan staining, cytoplasm is bright, alveolar endothelial cells proliferate, and Different degrees of interlobular fibrosis.

Lipid pneumonia prevention

Exogenous lipid pneumonia is mainly for prevention. Do not use liquid paraffin to drip nose and diarrhea.

Lipid pneumonia complications Complications, pulmonary heart disease

It can be complicated by fat embolism and lipid accumulation, and severe cases can be complicated by pulmonary heart disease.

Lipid pneumonia symptoms Common symptoms Dyspnea, night sweats, shortness of breath, hypoxemia, chills, nodules, respiratory alkalosis, low fever, pulmonary fibrosis

Most patients are asymptomatic, X-ray chest radiographs are abnormal to cause attention, common symptoms are cough, difficulty breathing after exercise, chest pain, hemoptysis, fever (often low fever), chills, night sweats and weight loss, physical examination without signs, Or fever, shortness of breath, chest auscultation is voiced, can hear bronchial or bronchoalveolar breath sounds and dry and wet voice or sputum pronunciation, arterial blood gas analysis can be normal, hypoxemia can occur after exercise, critically ill patients can Have hypoxemia, hypocapnia and mild respiratory alkalosis, pulmonary function test for restrictive ventilatory dysfunction, decreased lung compliance, sputum examination, visible macrophage in sputum, diameter 5 ~ 50mm Empty vacuoles, collected into a group, dark orange in Sudan staining, and the same stained extracellular small oil droplets, X-ray chest radiograph can be seen unilateral or bilateral infiltrates, showing a limited or diffuse distribution, more common double In the lower lung, the air bronchus sign can be seen. When fibrosis occurs, the lung capacity is reduced, there is a linear and nodular infiltration, and there is also a localized block shadow, like bronchial lung cancer.

Examination of lipid pneumonia

Macrophages in the sputum can be seen in vacuoles of 5 to 50 mm in diameter, which are aggregated into a group. When stained with Sudan, they are dark orange, and have the same stained extracellular small oil droplets, and the erythrocyte sedimentation rate is accelerated.

X-ray chest radiographs showed unilateral or bilateral infiltrates, showing localized or diffuse distribution, more common double lungs, air bronchial signs, lung fibrosis, lung volume reduction, linear and nodular infiltration, There are also localized block shadows, such as bronchial lung cancer, pulmonary function tests for restrictive ventilatory dysfunction, and decreased lung compliance.

Diagnosis and identification of lipid pneumonia

Diagnosis of lipid pneumonia depends on detailed medical history; the detection of lipid-rich macrophages in sputum is helpful for diagnosis, and there are block shadows in the lungs, which can be used for bronchoscopy lung biopsy (TBLB) to help identify other causes. The pulmonary fibrosis caused by the lungs and nodular masses must be differentiated from lung cancer.

There are block shadows in the lungs, which can be used for bronchoscopy lung biopsy (TBLB), which helps to identify pulmonary fibrosis caused by other causes, and nodules in the lungs must be differentiated from lung cancer.

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