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* Differentiating exogenous lipoid pneumonia from other diseases on the basis of radiologic features and specimen histologic features:<ref name="ParameswaranAnvari2000">{{cite journal|last1=Parameswaran|first1=K.|last2=Anvari|first2=M.|last3=Efthimiadis|first3=A.|last4=Kamada|first4=D.|last5=Hargreave|first5=F.e|last6=Allen|first6=C.j|title=Lipid-laden macrophages in induced sputum are a marker of oropharyngeal reflux and possible gastric aspiration|journal=European Respiratory Journal|volume=16|issue=6|year=2000|pages=1119–1122|issn=0903-1936|doi=10.1034/j.1399-3003.2000.16f17.x}}</ref>
* Differentiating exogenous lipoid pneumonia from other diseases on the basis of radiologic features and specimen histologic features:<ref name="ParameswaranAnvari2000">{{cite journal|last1=Parameswaran|first1=K.|last2=Anvari|first2=M.|last3=Efthimiadis|first3=A.|last4=Kamada|first4=D.|last5=Hargreave|first5=F.e|last6=Allen|first6=C.j|title=Lipid-laden macrophages in induced sputum are a marker of oropharyngeal reflux and possible gastric aspiration|journal=European Respiratory Journal|volume=16|issue=6|year=2000|pages=1119–1122|issn=0903-1936|doi=10.1034/j.1399-3003.2000.16f17.x}}</ref>
** Exogenous lipoid pneumonia is usually misdiagnosed as community-acquired pneumonia.
** Exogenous lipoid pneumonia is usually misdiagnosed as community-acquired pneumonia.
 
** It is considered usually as the initial diagnosis that does not lead to appropriate therapy.
** It is considered usually as the initial diagnosis does not lead to an appropriate therapy.
 
** In patients at risk of aspiration early CT scan is very useful for further diagnosis of lipoid pneumonia.
** In patients at risk of aspiration early CT scan is very useful for further diagnosis of lipoid pneumonia.
** Diagnosis is confirmed by detecting intra-alveolar lipid and lipid-laden macrophages.
** Diagnosis is confirmed by detecting intra-alveolar lipid and lipid-laden macrophages.
** specimens could be brought by:
** specimens could be brought by:
*** BAL (Broncho Alveolar Lavage)
*** BAL (Broncho Alveolar Lavage)
*** Transthorasic fine-needle aspiration cytology
*** Transthoracic fine-needle aspiration cytology
*** Biopsy from lesion
*** Biopsy from lesion


** Sputum examination has questionable reliability because lipid laden macrophages in sputum have been demonstrated in absence of lipoid pneumonia.
** Sputum examination has questionable reliability because lipid-laden macrophages in sputum have been demonstrated in the absence of lipoid pneumonia.
** BAL is widely available and choice of specimen taking today.
** BAL is widely available and the choice of specimen taking today.
** Frozen samples must be stained in order to determine type of the oil.
** Frozen samples must be stained in order to determine the type of oil.
** Since lipid-laden pneumonia is is very sensitive but may not be very specific, the diagnosis of exogenous lipoid pneumonia is based on the triad of:
** Since lipid-laden pneumonia is is very sensitive but may not be very specific, the diagnosis of exogenous lipoid pneumonia is based on the triad of:
**# History of mineral oil ingestion or vaping
**# History of mineral oil ingestion or vaping

Revision as of 13:44, 15 October 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ramyar Ghandriz MD[2]

Overview

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Differentiating lipoid pneumonia from other Diseases

  • Lipod pneumonia must be differentiated from other diseases that cause Cough with basilar infiltrates, such as bacterial pneumonia, viral pneumonia, congestive heart failure, pulmonary fibrosis, and aspiration pneumonia.[1]
  • Differentiating exogenous lipoid pneumonia from other diseases on the basis of radiologic features and specimen histologic features:[2]
    • Exogenous lipoid pneumonia is usually misdiagnosed as community-acquired pneumonia.
    • It is considered usually as the initial diagnosis that does not lead to appropriate therapy.
    • In patients at risk of aspiration early CT scan is very useful for further diagnosis of lipoid pneumonia.
    • Diagnosis is confirmed by detecting intra-alveolar lipid and lipid-laden macrophages.
    • specimens could be brought by:
      • BAL (Broncho Alveolar Lavage)
      • Transthoracic fine-needle aspiration cytology
      • Biopsy from lesion
    • Sputum examination has questionable reliability because lipid-laden macrophages in sputum have been demonstrated in the absence of lipoid pneumonia.
    • BAL is widely available and the choice of specimen taking today.
    • Frozen samples must be stained in order to determine the type of oil.
    • Since lipid-laden pneumonia is is very sensitive but may not be very specific, the diagnosis of exogenous lipoid pneumonia is based on the triad of:
      1. History of mineral oil ingestion or vaping
      2. compatible radiological findings
      3. presence of intra-alveolar lipids and/or lipid-laden macrophages
Diseases Diagnostic tests Physical Examination Symptoms Past medical history Other Findings
CT scan and MRI EKG Chest X-ray Tachypnea Tachycardia Fever Chest Pain Hemoptysis Dyspnea on Exertion Wheezing Chest Tenderness Nasalopharyngeal Ulceration Carotid Bruit
Pulmonary embolism
  • On CT angiography:
    • Intra-luminal filling defect
  • On MRI:
    • Narrowing of involved vessel
    • No contrast seen distal to obstruction
    • Polo-mint sign (partial filling defect surrounded by contrast)
 ✔ ✔ ✔ (Low grade) ✔ ✔ (In case of massive PE) ✔ - - - -
Congestive heart failure
  • Goldberg's criteria may aid in diagnosis of left ventricular dysfunction: (High specificity)
    • SV1 or SV2 + RV5 or RV6 ≥3.5 mV
    • Total QRS amplitude in each of the limb leads ≤0.8 mV
    • R/S ratio <1 in lead V4
 ✔ ✔ ✔ - - ✔ - - - -
Percarditis
  • ST elevation
  • PR depression
  • Large collection of fluid inside the pericardial sac (pericardial effusion)
  • Calcification of pericardial sac
 ✔ ✔ ✔ (Low grade) ✔ (Relieved by sitting up and leaning forward) - ✔ - - - -
  • May be clinically classified into:
    • Acute (< 6 weeks)
    • Sub-acute (6 weeks - 6 months)
    • Chronic (> 6 months)
Pneumonia ✔ ✔ ✔ ✔ - ✔ ✔ - - -
Vasculitis

Homogeneous, circumferential vessel wall swelling

✔ ✔ ✔ ✔ ✔ ✔ - ✔ ✔ ✔
Chronic obstructive pulmonary disease (COPD)
  • On CT scan:
  • On MRI:
    • Increased diameter of pulmonary arteries
    • Peripheral pulmonary vasculature attentuation
    • Loss of retrosternal airspace due to right ventricular enlargement
    • Hyperpolarized Helium MRI may show progressively poor ventilation and destruction of lung
 ✔ ✔ - - - ✔ ✔ - - -

References

  1. ↑ Bell MM (2015). "Lipoid pneumonia: An unusual and preventable illness in elderly patients". Can Fam Physician. 61 (9): 775–7. PMC 4569110. PMID 26371101.
  2. ↑ Parameswaran, K.; Anvari, M.; Efthimiadis, A.; Kamada, D.; Hargreave, F.e; Allen, C.j (2000). "Lipid-laden macrophages in induced sputum are a marker of oropharyngeal reflux and possible gastric aspiration". European Respiratory Journal. 16 (6): 1119–1122. doi:10.1034/j.1399-3003.2000.16f17.x. ISSN 0903-1936.

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