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Query: UMLS:C0019079 (hemoptysis)
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Exogenous lipoid pneumonia is a rare disease that has traditionally been considered a chronic condition secondary to continued aspiration or inhalation of fatty substances. An acute form may sometimes appear after a single and massive aspiration of lipid material, being a characteristic accident of street artists or "fire-eaters" that may generate acute respiratory failure. In this paper, we present clinical and radiological signs and outcome of two cases of lipoid pneumonia in "fire-eaters". A few hours after exposure patients may develop fever, cough, chest pain, hemoptysis, pulmonary infiltrates or hypoxemia. While diagnosis of chronic forms may require invasive procedures, recent exposure to fatty substances is a clue for clinical diagnosis in acute forms. Acute forms usually have a good outcome but cases evolving to cavitary pneumonia have been described. Some patients can present with acute respiratory distress syndrome and death. Treatment is based on general supportive measures.
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PMID:[Acute exogenous lipoid pneumonia in "fire-eaters". Description of two cases]. 1750 68

Three patients with exogenous lipoid pneumonia are presented. All of them had laryngectomy because of the cancer of larynx. In a period of time ranging from a few months up to a few years after the operation they started to have dyspnoea, cough, sometimes hemoptysis and slightly elevated temperature. The chest X-ray revealed massive opacities in the lower zones of both lungs suggesting lung cancer or metastases of the laryngeal cancer. HRCT showed ground glass lesions. Histological examination of the lungs detected accumulation of multiple macrophages with vacuolated foamy cytoplasms in the alveoli. Neoplastic disease was excluded. Additional data from the patients history revealed that all of them were inhaling or administering mineral oil-containing products through the tracheostomy. Exogenous lipoid pneumonia was diagnosed. Patients were asked to stop inhalations with the mineral oil.
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PMID:[Lipoid pneumonia in patients after laryngectomy]. 1854 53

Lipoid pneumonia, first described by Laughlen 1925 may be classified as endogenous or exogenous. The endogenous form is seen when fat is deposited into the lung tissue. It is usually associated with proximal obstructive lesions, necrotic tissue after radio- or chemotherapy, with lipid storage disease or hyperlipidemia . Exogenous lipoid pneumonia results from inhaling or aspirating animal, vegetable or mineral oil. There are usually some underlying neurological defects or esophageal abnormalities. Patients may present with cough, sputum, hemoptysis and chest pain or may be asymptomatic. There is no classic chest film appearance: it may appear as diffuse airspace infiltration or localized consolidation simulating tumour. Computed tomography is diagnostically helpful and shows hypodense areas measuring from -100 to - 30 Hounsfield units. Bronchoscopic biopsies are mandatory for histological confirmation of the diagnosis. Treatment of exogenous lipoid pneumonia has always been conservative by discontinuing the use of oil, correction of underlying defects that may favor aspiration and treatment of intercurrent pneumonia. Other measures, for example corticosteroid therapy, are of uncertain benefit. Complications of lipoid pneumonia that worsen prognosis are recurrent bacterial pneumonias including nontuberculous mycobacteria or aspergillus, or lung cancer that has developed in areas of pre-existing exogenous lipoid pneumonia.
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PMID:[Lipoid pneumonia - an underestimated syndrome]. 2002 81

Lipoid pneumonia is a rare medical condition, and is usually classified into two groups, ie, exogenous or endogenous, depending on the source of lipids found in the lungs. Exogenous lipoid pneumonia may result from the aspiration of food and lipids. Although most cases are asymptomatic, common symptoms include cough, dyspnea, chest pain, pleural effusions, fever, and hemoptysis. Radiologically, lipoid pneumonia can manifest as consolidations, pulmonary nodules, or soft-tissue densities. These presentations involve a wide differential diagnosis, including lung cancer. Other rare causes of fatty pulmonary lesions include hamartomas, lipomas, and liposarcomas. The avoidance of further exposures and the use of corticosteroids, antibiotics, and lavage comprise the mainstays of treatment. The exclusion of mycobacterial infections is important during diagnosis, in view of their known association. Generally, acute presentations run a benign course, if promptly treated. Chronic cases are more persistent and difficult to treat. Although the radiologic and pathologic diagnosis is fairly reliable, more research is needed to clarify the optimal treatment and expected outcomes. We report on a 54-year-old man presenting with progressively worsening cough, hemoptysis, and dyspnea over a few weeks. The patient underwent multiple computed tomographies of the chest and bronchoscopies. All failed to diagnose lipoid pneumonia. The diagnosis was finally established using video-assisted thoracoscopic surgery. Most of the paraffinoma was resected during this surgery. He was treated with antibiotics and steroids, and discharged from the hospital in stable condition.
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PMID:Lipoid pneumonia: a challenging diagnosis. 2213 5

Lipoid pneumonia is an uncommon disease caused by the presence of lipid in the alveoli. Here we described a case of a 50-year-old woman with haemoptysis, cough and tachypnea, who was diagnosed with cholesterol pneumonia accompanying with pulmonary artery hypertension. The extremely high pulmonary artery pressure achieved, in this case, is alarming and should alert the physicians that the cholesterol pneumonia may be one of the underlying causes of pulmonary artery hypertension. After a treatment of methylprednisolone, her clinical symptoms were significantly improved, which suggested that steroid might be a promising therapeutic for patients with cholesterol pneumonia.
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PMID:A 50-year-old woman with haemoptysis, cough and tachypnea: cholesterol pneumonia accompanying with pulmonary artery hypertension. 2607 19

Exogenous lipoid pneumonia (ELP) is caused by the inhalation of vaporized oily products. Long-term exposure can result in chronic disease, whereas acute form usually results from massive aspiration of fatty substances. It has an incidence of 1.0%-2.5%. In case of symptomatic patients, the clinical presentation mainly includes acute or chronic respiratory symptoms such as dyspnea, fever, cough and less frequently chest pain, hemoptysis, or weight loss. Radiological findings are often aspecific or misinterpreted, and ELP is sometimes misdiagnosed as a malignancy of the lungs. Patient history and radiological findings can lead to a suspicion of ELP, but histological microscopic findings of intra-alveolar lipid and lipid-laden macrophages are required to confirm the diagnosis The mainstay of treatment consists of avoiding ongoing exposure and providing supportive care as repeated whole-lung lavage, corticosteroids, and/or immunoglobulins. Surgery is reserved for cases of high suspicion of cancer or serious clinical impact (as recurrent infections). Prognosis is benign, even if it has been reported cases of progression to severe respiratory failure, cor pulmonale, superinfection, and association with lung cancer. Here, we describe a case of ELP due to chronic inhalation of oily product (Vaseline) used as a lubricant of tracheotomy cannula.
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PMID:Exogenous Lipoid Pneumonia due to Chronic Inhalation of Oily Product Used as a Lubricant of Tracheotomy Cannula. 3000 81