de Cuba E M V, Vreuls W, Tan C G, Flieder D B, Thunnissen E
Department of Pathology, VU University Medical Center, Room 0E48, De Boelelaan 1117 1081 HV, Amsterdam, The Netherlands.
Nederlands Kanker Instituut, Amsterdam, The Netherlands.
Virchows Arch. 2024 Dec 19. doi: 10.1007/s00428-024-04000-6.
Lipoid pneumonia is a rare entity most often associated with inhalation of foreign material (i.e. "fire-eater's lung"), silicone injection, and severe trauma. We present the case of a 61-year old man who developed acute respiratory distress syndrome following endoscopic retrograde cholangiopancreatography (ERCP) for cholelithiasis. Intensive care supportive therapy included mechanical ventilation, dialysis, and total parenteral nutrition. Unresolved pneumothorax necessitated lobectomy. Histology of the lobectomy specimen demonstrated massive intra-alveolar haemorrhage and numerous alveolar septal macrophages with clear cytoplasmic vacuoles. These findings were diagnostic of interstitial lipoid pneumonia due to intravenous administration of lipid emulsions. The differential diagnosis is also discussed. Although rare, interstitial lipoid pneumonia should be considered in critically ill patients presenting with an interstitial pattern of lung disease after intravenous administration of lipid emulsions.
脂质性肺炎是一种罕见疾病，最常与异物吸入（即“吞火者肺”）、硅酮注射和严重创伤相关。我们报告一例61岁男性病例，该患者因胆结石接受内镜逆行胰胆管造影术（ERCP）后发生急性呼吸窘迫综合征。重症监护支持治疗包括机械通气、透析和全胃肠外营养。未解决的气胸需要进行肺叶切除术。肺叶切除标本的组织学检查显示大量肺泡内出血以及众多含有清晰胞质空泡的肺泡间隔巨噬细胞。这些发现诊断为静脉注射脂质乳剂导致的间质性脂质性肺炎。文中还讨论了鉴别诊断。尽管罕见，但对于静脉注射脂质乳剂后出现间质性肺病模式的重症患者，应考虑间质性脂质性肺炎。
