Recurrent aspiration in children: Lipid‐laden alveolar macrophage quantitation

Colombo, John L.; Hallberg, Timothy K.

doi:10.1002/ppul.1950030209

Cited by 160 publications

(147 citation statements)

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“…BAL was done in this segment and the recovered fluid was milky white in appearance, with fat globules floating on the surface. Oil red O staining of BAL fluid demonstrated high numbers of lipid-laden macrophages (Fig 3) with an index of 280 6 and free droplets of extracellular oil. Viral, bacterial, fungal, and mycobacterial studies on the BAL specimen were negative.…”

Section: Case Reportmentioning

confidence: 99%

Lipoid Pneumonia: A Silent Complication of Mineral Oil Aspiration

1999

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ABSTRACT. Introduction. Chronic constipation is a common symptom in pediatrics, and physicians often use mineral oil to treat chronic constipation in children. Mineral oil, a hydrocarbon, may not elicit a normal protective cough reflex and may impair mucociliary transport. These effects can increase the likelihood of its aspiration and subsequent impaired clearance from the respiratory tract. We report a case of a child with neurodevelopmental delay with chronic constipation and a history of chronic mineral oil ingestion presenting as asymptomatic exogenous lipoid pneumonia (ELP).Case History. A 6-year-old white boy with a history of developmental delay was found to have an infiltrate in his right upper lobe on a chest radiograph obtained during evaluation for thoracic scoliosis. The patient had a long history of constipation with daily use of mineral oil. He was fed by mouth and had occasional episodes of coughing and choking during feeding. He was asymptomatic at presentation and physical examination was unremarkable. The patient was advised to stop administration of the mineral oil and was treated empirically with antibiotics during a 3-month period. At follow-up examination the patient continued to be asymptomatic, with the radiologic persistence of the infiltrate. Diagnosis of lipoid pneumonia was made by diagnostic bronchoscopy with bronchoalveolar lavage (BAL). The exogenous origin of the lipid in the BAL fluid was confirmed by gas chromatography/mass spectrometry.Discussion. The clinical presentation of ELP is nonspecific and ranges from the totally asymptomatic patient with incidental radiologic finding, like our patient, to the patient with acute or chronic symptoms attributable to pneumonia, pulmonary fibrosis, or cor pulmonale. Bronchoscopy with BAL can be successful in establishing the diagnosis of ELP by demonstration of a high lipid-laden macrophage index. Treatment of ELP in children is generally supportive, with the symptoms and roentgenographic abnormalities resolving within months after stopping the use of mineral oil.Conclusion. Lipoid pneumonia as a result of mineral oil aspiration still occurs in the pediatric population. It can mimic other diseases because of its nonspecific clinical presentation and radiographic signs. In patients with swallowing dysfunction and pneumonia, a history of mineral oil use should be obtained and a diagnosis of ELP should be considered in the differential diagnoses if mineral oil use has occurred. Our case points to the need for increased awareness by the general pediatricians of the potential hazards of mineral oil use for chronic constipation. Pediatrics 1999;103(2). URL: http://www. pediatrics.org/cgi/content/full/103/2/e19; bronchoalveolar lavage, constipation, exogenous lipoid pneumonia, lipidladen macrophages, mineral oil.ABBREVIATIONS. RUL, right upper lobe; CXR, chest x-ray; BAL, bronchoalveolar lavage; ELP, exogenous lipoid pneumonia. C hronic constipation, a common symptom in pediatrics, accounts for 3% of referrals to teaching hospital clinics and 10...

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Section: Case Reportmentioning

confidence: 99%

Lipoid Pneumonia: A Silent Complication of Mineral Oil Aspiration

1999

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“…Accumulation of lipids in the cytoplasm of alveolar macrophages is considered to be evidence of aspiration [5,6]. The amount of lipids in alveolar macrophages can be quantitated and expressed as the lipid-laden index (LLI) [7,8]. This index takes into account both the number of macrophages containing lipids, and the relative amount of lipids present in the macrophages.…”

mentioning

confidence: 99%

Lipid-laden macrophage index and inflammation in bronchoalveolar lavage fluids in children

Kazachkov

Muhlebach²,

Livasy³

et al. 2001

European Respiratory Journal

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“…Bronchoscopy with bronchoalveolar lavage for lipidladen macrophages can evaluate the possibility of reflux-associated aspiration. A Colombo Index > 70 indicates aspiration, but does not differentiate secondary aspiration due to reflux from primary aspiration with swallowing [33]. Esophageal or post-cricoid biopsies are other informative procedures also easily performed at the time of DL and B. Intraepithelial eosinophils or basal epithelial zone hyperplasia confirm the presence of esophagitis, but these findings can be due to primary eosinophilic esophagitis as well as reflux induced inflammation [34].…”

Section: Conmentioning

confidence: 99%

Does Reflux Have a Causative Role in Laryngomalacia?

Manaligod¹

2013

Otolaryngology

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Recurrent aspiration in children: Lipid‐laden alveolar macrophage quantitation

Cited by 160 publications

References 13 publications

Lipoid Pneumonia: A Silent Complication of Mineral Oil Aspiration

Lipoid Pneumonia: A Silent Complication of Mineral Oil Aspiration

Lipid-laden macrophage index and inflammation in bronchoalveolar lavage fluids in children

Does Reflux Have a Causative Role in Laryngomalacia?

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