Wright B A, Jeffrey P H
Department of Pathology, Halifax Infirmary, Camp Hill Medical Centre, Nova Scotia, Canada.
Semin Respir Infect. 1990 Dec;5(4):314-21.
The most common sources for lipids producing radiographic or clinical evidence of disease in the lungs are endogenous lipids and inhaled (exogenous) mineral oil. Endogenous lipoid pneumonia arises when lung tissue breaks down distal to an obstructed airway leading to the release of cholesterol and other lipids, producing airspace disease. Exogenous lipoid pneumonia occurs most frequently in the elderly following habitual mineral oil use. Many patients have no specific predisposing cause for aspiration of the ingested mineral oils. Symptoms, found in only half of the patients reviewed, include chronic cough and sputum production. Radiographically, the lesions are usually ill-defined radiopacities that mimic carcinoma of the lung. The inhaled mineral oil incites a foreign-body reaction, producing a granuloma with multinucleated foreign-body giant cells and fibrosis surrounding lipid droplets. Diagnostic strategies such as sputum examination for lipids and transthoracic needle aspiration are discussed. These procedures may help to avoid thoracotomy in elderly, often debilitated patients with lipoid pneumonia.
导致肺部出现影像学或临床疾病证据的脂质最常见来源是内源性脂质和吸入的（外源性）矿物油。当肺组织在阻塞气道的远端发生分解，导致胆固醇和其他脂质释放，从而产生气腔疾病时，就会发生内源性类脂性肺炎。外源性类脂性肺炎最常发生在习惯性使用矿物油的老年人中。许多患者没有吸入摄入矿物油的特定易感因素。在接受检查的患者中，只有一半出现症状，包括慢性咳嗽和咳痰。在影像学上，病变通常是边界不清的不透光区，类似肺癌。吸入的矿物油引发异物反应，产生含有多核异物巨细胞的肉芽肿以及围绕脂质小滴的纤维化。文中讨论了诸如痰液脂质检查和经胸针吸活检等诊断策略。这些程序可能有助于避免对患有类脂性肺炎的老年体弱患者进行开胸手术。
