대 한 방 사 선 의 학 회 지 1991 ; 27 (5) : 644~646
Journal of Korean Radiological Society, September, 1991
Exogenous Lipoid Pneumonia after Ingestion of Shark Liver Oil:
A Case Report
Jae Bum Yang
,
M.D.,
Hyeon Lim Seong M.D.,
Chan Sup Park,
M.D.*,
Yang Hee Park
,
M.D.,
Sang Sun Lee,
M.D.Department o[ Radiology, National Police Hospital
Exogenous lipoid pneumonia was first described in 1925 by Laughlen and a sizeble literature developed. reaching a peak in the 1940s. Two cases of exogenous lipoid pneumonia in children were reported domestically.
We wish to report a case of exogenous lipoid pneumonia presented with bilateral air-space consolidation in a 53-year-old man who had a long history of ingestion of shark liver oil. This report describes its radiological findings. along with a review of the literature.
Index Words: Lung. diease Lung. CT. 60.1211
Lung. lipoid pneumonia. 60.253
Introduction
Exogenous lipoid pneumonia is an uncommon disorder at present. Exogenous lipoid pneumonia which results from aspiration of oil presents a difficult diagnostic problem for both clinician and radiologist because it may mimic many diseases. ln this report, lipoid pneumonia was suggested by chest radiograph and computed tomogram (CT). supported by a long history of shark liver oil ingestion. The diagnosis was confirmed by detecting oil droplets in the bronchial washings.
Case Report
A 53-year-old male was admitted to the National Police Hospital with fever. left chest pain and cough for 15 days. He had resituals neural clefiate of cerebral infarction with left hemiparesis. Physical examina-
visual acuity for two years Laboratory studies demonstrated anemia (hemoglobin. 10.0 g/dll and leukocytosiS (16.00m/mm) with a lymphocyte count
of 12"10. The patient had a history of taking Squalen@
(shark liver oil) for two years
A chest radiograph demonstrated ill defined homogeneous haziness with air bronchograms in both lower lobes (Fig. 1). High resolution CT mainly showed mixed interstitial reticular density in portions of both lungs and diffuse air-space consolidations bilaterally without evidence of bronchial obstruction (Fig. 2). The density of the lesion was slightly lower than that muscle
In respiratory secretion, sputum examination showed numerous lipoid laden alveolar macropharges ofvarying sizes. consistent with lipoid pneumonia (Fig. 3).
Discussion
tion revealed rales on both lower lung fields and Domestically two cases of exogenous lipoid tongue deviation to the left. representing facial palsy. pneumonia in children have been reported by Chang In addition. he had slurred speech and decreased Gee Gang and Jeong Wan YoO'-2'. A history ofusage
*인하대학교 의과대학 방사선과학교실
*Department of Radiology. lnha University Hospital
이 논문은 1990년 12월 21 일 접수하여 1991 년 7 월 8 일에 채택되었음.
Received December 21. 1990. accepted July 8. 1991
644 -
Jae Bum Yang et al: Exogenous Lipoid Pneulllonia after Ingestion of Shark Liver Oil
Fig. 1. Chest radiograph shows i1l defined homogeneous hazines predominentJy in both lung fields with air bron.
chograms. And streaky density and calcifications in up. per lobe represents inactive pulmonary tuberculosis
Fig. 2. High resolution CT at the level of the inferior pulmonary vein shows diffuse air-space consolidations bilatera1ly and interstitial infiltrations with reticular and ground.glass density
of shark liver oil was obtained alI
Exogenous lipOid pneumonia is a chronic. acinar or interstitial. proliferative inf1ammatory disease resulting from aspiration of oil material. It has been encounted in patients who use mineral oil. such as liquid paraffin for constipation and in nose drops‘
animal oils. such as cod liver given to children‘ and vegetable oils. sesame oil used in medical suspensions(3.9). The incidence is higher in older pa.
‘
‘
•
Fig.3. Smear of lung sputum cytology shows multiple vacuolated macrophages with fat vacuoles (Papanicolau stain. x400)
tients with underlying debility(lü)
The mechanism of oil aspiration could be due. to the inhibitory action of the shark liver oil to stimulate the cough ref1ex(6). Habitual consumption before retiring may rcsult in pooling of the shark liver oil in the pharynx with subsequent aspiration during sleep(4-9). In addition. shark liver oil has been shown to inhibitciliary action when present in large quanti.
ty. with resultant failure to clear aspirated material from the tracheobroncheal tree( 11). The clinical presentations range from occasional cough to severe respiratory difficulties.
The radiologic manifestations of exogenous lipoid pneumonia vary from a solitary lipoid granuloma or large consolidations simulating carcinoma to an ex. tensive bronchopneumonia( 12). CT scans can help by detecting fat in lung mass. The typical radiologic fin dings show a bilateralIy diffuse perihilar or centralIy ill defined nodular or conf1uent air.space consolida tion which is usually more severe in the base( 13.17) ln most cases lower lobes are affected. ln debilitated patients. because of their recumbent positions. in- volvement is likely to occur in the superior segment of a lower lobe or the posterior segment of an upper lobe( 18). The differential diagnosis of lipoid pneumonia includes pulmonary edema. tuberculosis.
bacterial pneumonia. fungal infection. alve이 ar pro.
teinosis. bronchioloalveolar carcinoma or metastatic cancer. pneumOCOl1l0S1S‘ hypersentitivity pneumoni.
tis and pulmonary fjbrosis. Treatment consists of discontinuing the use of the oppending oil and rare
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Journal 01 Korean Radiology Society 1991; 2 7( 51: 644-646
ly is surgical removal necessary( 17). Although past history of ingestion of oily substance can easily be forgotten by the patients. it is vital to establish the diagnosis for treatment. Exacl diagnosis requires detection of the oil droplets either by sputum ex- aminalion‘ aspiration biopsy. or by surgical resection( 19)
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2 유정환， 박환규， 손영모. 컴퓨터단충촬영으로 진단된 지방성 폐렴 l 례. 대한의학협회지 1990; 33 : 921-925 3. Berg R. Burford TH. Pulmonary parafTinoma (lipoid
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〈국문 요약〉
caused by metenamide mandelate suspension.
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스쿠알렌 복용후 발생한 외인성 지방성 페럼 -1 려| 보고-
국립경찰병원 방사선과 인하대학교 의과대학 방사선과학교실*
양재범·성현럼·박찬섭*박양희·이상선
외인성 지방성 폐렴은 1925년 Laughlen 에 의해 처음 보고되었고 1940년대에 활발한 보고가 있었으나 그후 감소하는 추세였다. 국내에서는 소아 환자에서 2 례 보고되었다
저자들은 최근에 뇌경색에 의한 우측 면마비 상태의 53 세 냥자환자가 장기간 액체상태의 스쿠알헨a (Shark liver oil) 복용한 후 방사선학적 양측성 기강 정결(air.space consolidation)으로 발현하였으며 기관지경검사에서 지방성 droplet 의 발견으로 지방성 폐렴으로 확진된 l례를 경험하였기에 문헌 고찰과 함께 보고하고자 한다
