Bronchoscopy in lipoid pneumonia.

Abstract

Patients and methods Children with resistant or recurrent pneumonia presenting over a three year period to Asir Central Hospital, the only tertiary care facility in the region, were studied. All the children were referred to the otolaryngologist by paediatricians. A detailed history including history of feeding of saman was obtained in each case. A chest radiograph was performed before bronchoscopy.Bronchoscopy was carried out by using a Storz ventilating paediatric bronchoscope of the appropriate size. Any secretion in the trachea or bronchi was aspirated using a sterile suction connected to a 'mucus trap'. When secretions were scanty, bronchial lavage was carried out by instilling 1-2 ml of sterile normal saline into the tracheobronchial tree and aspirating the contents after ventilating a few times. The aspirate was viewed macroscopically against a bright light and any oily droplets floating on the surface were noted. The aspirate was subjected to microbiological studies, including Gram and Ziehl-Neelsen staining, appropriate bacterial and fungal cultures, and special stain for fat (oil red 0). The gross bronchoscopic findings such as the state of the mucus membrane, the presence or absence of secretions, their nature, and presence of any other endobronchial pathology were noted. Chest radiographs were repeated within 24 hours ofperforming the bronchoscopy. The condition of the patient at follow up, particularly at one month after bronchoscopy, was also noted. All data were entered into a SPSS/PC computer program for analysis. figure.

Lipoid Pneumonia: A Silent Complication of Mineral Oil Aspiration

“…The macroscopic appearance of BAL with fat globules on the fluid surface and the cytologic demonstration of lipid-laden macrophages 14 is consistent with the diagnosis of ELP. Kameswaran et al 15 reported a series of 24 cases of lipoid pneumonia in children, 22 of which were diagnosed by rigid bronchoscopy with BAL. Bronchoscopy has the additional advantage of assessment of airway anatomy to rule out other causes of chronic nonresolving pneumonia.…”

Squalene‐induced exogenous lipoid pneumonia in an infant

“…Lipid‐laden macrophages are the cytological finding and therefore, invasive methods such as fine‐needle aspiration and open lung biopsy have been advocated 6 . Bronchoscopy with bronchial lavage is considered a reliable and minimally invasive diagnostic method 7 . In the present case, BAL and open lung biopsy were performed and the oil red O stain was positive for exogenous lipid and foamy macrophages in the lung.…”

Exogenous lipoid pneumonia in children: A systematic review

“…These oils were used for three main reasons: (1) cultural (2) medical or (3) behavioural. Ghee (rendered animal fat) and olive oil were commonly documented in studies from Saudi Arabia and India for which they were used culturally for oral/nasal cleansing purposes in oil baths, as a laxative, for nutritional supplements, to prevent coughs and colds and to generally promote good health [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Shark liver oil was mainly reported in South Korea for cultural reasons [23].…”

“…Corticosteroid use was reported in 20 studies and administered by different routes; intravenous dexamethasone at 0.3 mg/kg was given for two weeks [45], prednisone was administered at 1-2 mg/kg/day from 2 weeks to 14 months [10,18,19,24,28,31,47], and inhaled beclomethasone was given at 250 mcg 12 hourly for 6 months [47]. Therapeutic partial or whole lung lavage [12,24,25,27,39,43,46] and surgical resection were additional treatment modalities reported in children with ELP [7,10,11,22,42,44].…”