Lipoid pneumonia pathophysiology: Difference between revisions

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{{CMG}}; {{AE}} {{RG}}
==Overview==
==Overview==
lipoid pneumonia parthenogenesis is different in its two sub-types: exegenous form:it is understood that exogenus [[lipoid pneumonia]] is the result of chronic body reaction to fatty substance in the [[alveoli|alveol]]. [[lipid]] reaches [[alveoli]] by [[aspiration]] or [[inhalation]]. Some [[Oils|mineral oils]] can cause lung injuries such as [[Natural gasoline|gasoline]]. mineral oils can enter the [[tracheobronchial tree]] without causing [[cough reflex]] which will bother [[Mucociliary clearance|mucociliary transport system]] chronically. injected lipids mechanism of further producing [[lipid pneumonia]] is more complicated. as the [[lipid]] goes inside the [[alveoli]], it is trapped and hard to expectorate, this condition may be worsen by associated [[neurological]] and [[gastrointestinal]] disorders affecting [[swallowing]] or [[cough]]. lipids in [[alveoli]] form [[emulsion]] and then consumed by [[macrophages]] via [[phagocytosis]]. since the [[Macrophages|alveolar macrophages]] cannot metabolize consumed fatty substance, [[oil]] is repeatedly released into [[alveoli]] after death of these [[macrophages]]. The oil released, illicits a [[Granulomatosis|giant-cell granulomatosis]] reaction.
lipoid pneumonia parthenogenesis is different in its two sub-types: Exegenous form:it is understood that exogenus [[lipoid pneumonia]] is the result of chronic body reaction to fatty substance in the [[alveoli|alveol]]. [[Lipid]] reaches [[alveoli]] by [[aspiration]] or [[inhalation]]. Some [[Oils|mineral oils]] can cause lung injuries such as [[Natural gasoline|gasoline]]. Mineral oils can enter the [[tracheobronchial tree]] without causing [[cough reflex]] which will bother [[Mucociliary clearance|mucociliary transport system]] chronically. Injected lipids mechanism of further producing [[lipid pneumonia]] is more complicated. As the [[lipid]] goes inside the [[alveoli]], it is trapped and hard to expectorate, this condition may be worsen by associated [[neurological]] and [[gastrointestinal]] disorders affecting [[swallowing]] or [[cough]]. Lipids in [[alveoli]] form [[emulsion]] and then consumed by [[macrophages]] via [[phagocytosis]]. Since the [[Macrophages|alveolar macrophages]] cannot metabolize consumed fatty substance, [[oil]] is repeatedly released into [[alveoli]] after death of these [[macrophages]]. The oil released, illicits a [[Granulomatosis|giant-cell granulomatosis]] reaction. Endogenous form: The pathogenesis of endogenous [[lipoid pneumonia]] is still not well understood however there are plenty of suggested mechanisms, endogenous [[lipoid pneumonia]] can be caused by [[Bronchial|transbronchial]] dissemination of [[cancer cell]] breakdown products. Poorly differentiated [[adenocarcinoma]] cells secreting [[mucin]] is the most common [[neoplastic]] reason. Another mechanism suggested is [[Anoxic brain injury|anoxic tissue injury]] stimulating various [[enzymes]] such as [[phospholipase]] and [[Monooxygenase|mono-oxygenases]].[[Infection]] changes to endogenous [[lipid pneumonia]] is generally localized in airways because the souronding [[lung]] is already [[Consolidation (medicine)|consolidated]], limiting the spread of [[bacteria]]. On gross and microscopic [[histology]] well circumscribed, firm with prominent [[lymphatics]] on lung surface in exogenous typelipoid material (or empty spaces), [[Inflammation|inflammatory cells]] and young [[Fibroblast|fibroblasts]]. [[Endarteritis obliterans|Reactive endarteritis]], marked [[alveolar]] lining cell [[hyperplasia]]. Lipid-laden foamy [[Macrophage|macrophages]] are seen.
 
endogenous form: the pathogenesis of endogenous [[lipoid pneumonia]] is still not well understood however there are plenty of suggested mechanisms, endogenous [[lipoid pneumonia]] can be caused by [[Bronchial|transbronchial]] dissemination of [[cancer cell]] breakdown products. poorly differentiated [[adenocarcinoma]] cells secreting [[mucin]] is the most common [[neoplastic]] reason. another mechanism suggested is [[Anoxic brain injury|anoxic tissue injury]] stimulating various [[enzymes]] such as [[phospholipase]] and [[Monooxygenase|mono-oxygenases]].[[Infection]] changes to endogenous [[lipid pneumonia]] is generally localized in airways because the souronding [[lung]] is already [[Consolidation (medicine)|consolidated]], limiting the spread of [[bacteria]].  
 
On gross and microscopic [[histology]] well circumscribed, firm with prominent [[lymphatics]] on lung surface in exogenous typelipoid material (or empty spaces), [[Inflammation|inflammatory cells]] and young [[Fibroblast|fibroblasts]]. [[Endarteritis obliterans|Reactive endarteritis]], marked [[alveolar]] lining cell [[hyperplasia]]. lipid-laden foamy [[Macrophage|macrophages]] are seen.


== Pathophysiology ==
== Pathophysiology ==


=== Exogenous lipoid pneumonia ===
=== Exogenous lipoid pneumonia ===
The important pathophysiology aspects regarding expgenous lipoid pneumonia include:<ref name="GuerguerianLacroix2000">{{cite journal|last1=Guerguerian|first1=Anne-Marie|last2=Lacroix|first2=Jacques|title=Pulmonary injury after intravenous hydrocarbon injection|journal=Paediatrics & Child Health|volume=5|issue=8|year=2000|pages=471–472|issn=1205-7088|doi=10.1093/pch/5.8.471}}</ref><ref name="DomejMitterhammer2007">{{cite journal|last1=Domej|first1=Wolfgang|last2=Mitterhammer|first2=Heike|last3=Stauber|first3=Rudolf|last4=Kaufmann|first4=Peter|last5=Smolle|first5=Karl Heinz|title=Successful outcome after intravenous gasoline injection|journal=Journal of Medical Toxicology|volume=3|issue=4|year=2007|pages=173–177|issn=1556-9039|doi=10.1007/BF03160935}}</ref>


*It is understood that exogenus [[lipoid pneumonia]] is the result of chronic body reaction to fatty substance in the [[alveoli]]<ref name="GuerguerianLacroix2000">{{cite journal|last1=Guerguerian|first1=Anne-Marie|last2=Lacroix|first2=Jacques|title=Pulmonary injury after intravenous hydrocarbon injection|journal=Paediatrics & Child Health|volume=5|issue=8|year=2000|pages=471–472|issn=1205-7088|doi=10.1093/pch/5.8.471}}</ref>.
*It is understood that exogenus [[lipoid pneumonia]] is the result of chronic body reaction to fatty substance in the [[alveoli]].
*[[Lipid]] reaches [[alveoli]] by [[aspiration]] or [[inhalation]].
*[[Lipid]] reaches [[alveoli]] by [[aspiration]] or [[inhalation]].
*Some [[Oils|mineral oils]] can cause lung injuries such as [[Natural gasoline|gasoline]]<ref name="DomejMitterhammer2007">{{cite journal|last1=Domej|first1=Wolfgang|last2=Mitterhammer|first2=Heike|last3=Stauber|first3=Rudolf|last4=Kaufmann|first4=Peter|last5=Smolle|first5=Karl Heinz|title=Successful outcome after intravenous gasoline injection|journal=Journal of Medical Toxicology|volume=3|issue=4|year=2007|pages=173–177|issn=1556-9039|doi=10.1007/BF03160935}}</ref>.
*Some [[Oils|mineral oils]] can cause lung injuries such as [[Natural gasoline|gasoline]].
*Mineral oils can enter the [[tracheobronchial tree]] without causing [[cough reflex]] which will bother [[Mucociliary clearance|mucociliary transport system]] chronically.
*Mineral oils can enter the [[tracheobronchial tree]] without causing [[cough reflex]] which will bother [[Mucociliary clearance|mucociliary transport system]] chronically.
*Injected lipids mechanism of further producing [[lipid pneumonia]] is more complicated:
*Injected lipids mechanism of further producing [[lipid pneumonia]] is more complicated:
**It is suggested that the [[lung]] is the first [[capillary bed]] encountered during [[circulation]], bearing the majority of damage.
**It is suggested that the [[lung]] is the first [[capillary bed]] encountered during [[circulation]], bearing the majority of damage.
*as the [[lipid]] goes inside the [[alveoli]], it is trapped and hard to expectorate, this condition may be worsen by associated [[neurological]] and [[gastrointestinal]] disorders affecting [[swallowing]] or [[cough]].
*As the [[lipid]] goes inside the [[alveoli]], it is trapped and hard to expectorate, this condition may be worsen by associated [[neurological]] and [[gastrointestinal]] disorders affecting [[swallowing]] or [[cough]].
*Lipids in [[alveoli]] form [[emulsion]] and then consumed by [[macrophages]] via [[phagocytosis]].
*Lipids in [[alveoli]] form [[emulsion]] and then consumed by [[macrophages]] via [[phagocytosis]].
*Since the [[Macrophages|alveolar macrophages]] cannot metabolize consumed fatty substance, [[oil]] is repeatedly released into [[alveoli]] after death of these [[macrophages]].
*Since the [[Macrophages|alveolar macrophages]] cannot metabolize consumed fatty substance, [[oil]] is repeatedly released into [[alveoli]] after death of these [[macrophages]].
Line 32: Line 29:


=== Endogenous lipoid pneumonia ===
=== Endogenous lipoid pneumonia ===
The pathogenesis of endogenous [[lipoid pneumonia]] is still not well understood however there are plenty of suggested mechanisms:<ref name="BurkeFraser1988">{{cite journal|last1=Burke|first1=M|last2=Fraser|first2=R|title=Obstructive pneumonitis: a pathologic and pathogenetic reappraisal.|journal=Radiology|volume=166|issue=3|year=1988|pages=699–704|issn=0033-8419|doi=10.1148/radiology.166.3.3340764}}</ref><ref name="urlwww.thoracic.org">{{cite web |url=https://www.thoracic.org/statements/resources/interstitial-lung-disease/online-supplement-clinical-utility-blcaild.pdf |title=www.thoracic.org |format= |work= |accessdate=}}</ref><ref name="CohenCline1972">{{cite journal|last1=Cohen|first1=Allen B.|last2=Cline|first2=Martin J.|title=In VitroStudies of the Foamy Macrophage of Postobstructive Endogenous Lipoid Pneumonia in Man1–3|journal=American Review of Respiratory Disease|volume=106|issue=1|year=1972|pages=69–78|issn=0003-0805|doi=10.1164/arrd.1972.106.1.69}}</ref>


* The pathogenesis of endogenous [[lipoid pneumonia]] is still not well understood however there are plenty of suggested mechanisms:<ref name="BurkeFraser1988">{{cite journal|last1=Burke|first1=M|last2=Fraser|first2=R|title=Obstructive pneumonitis: a pathologic and pathogenetic reappraisal.|journal=Radiology|volume=166|issue=3|year=1988|pages=699–704|issn=0033-8419|doi=10.1148/radiology.166.3.3340764}}</ref><ref name="urlwww.thoracic.org">{{cite web |url=https://www.thoracic.org/statements/resources/interstitial-lung-disease/online-supplement-clinical-utility-blcaild.pdf |title=www.thoracic.org |format= |work= |accessdate=}}</ref><ref name="CohenCline1972">{{cite journal|last1=Cohen|first1=Allen B.|last2=Cline|first2=Martin J.|title=In VitroStudies of the Foamy Macrophage of Postobstructive Endogenous Lipoid Pneumonia in Man1–3|journal=American Review of Respiratory Disease|volume=106|issue=1|year=1972|pages=69–78|issn=0003-0805|doi=10.1164/arrd.1972.106.1.69}}</ref>.
*Most proven mechanisms are :
**Most proven mechanisms are :
** Retained [[epithelial]] [[secretion]]
*** Retained [[epithelial]] [[secretion]]
**[[Cell]] breakdown
***[[Cell]] breakdown
** Leakage from [[vessels]]
*** Leakage from [[vessels]]
** Prolonged [[hypoxia]]
*** Prolonged [[hypoxia]]
** Local [[oxygen]] and [[carbon dioxide]] tension.
*** Local [[oxygen]] and [[carbon dioxide]] tension.
*Endogenous [[lipoid pneumonia]] can be caused by [[Bronchial|transbronchial]] dissemination of [[cancer cell]] breakdown products.<ref name="TamuraHebisawa1998">{{cite journal|last1=Tamura|first1=A.|last2=Hebisawa|first2=A.|last3=Fukushima|first3=K.|last4=Yotsumoto|first4=H.|last5=Mori|first5=M.|title=Lipoid Pneumonia in Lung Cancer: Radiographic and Pathological Features|journal=Japanese Journal of Clinical Oncology|volume=28|issue=8|year=1998|pages=492–496|issn=0368-2811|doi=10.1093/jjco/28.8.492}}</ref>
**Endogenous [[lipoid pneumonia]] can be caused by [[Bronchial|transbronchial]] dissemination of [[cancer cell]] breakdown products<ref name="TamuraHebisawa1998">{{cite journal|last1=Tamura|first1=A.|last2=Hebisawa|first2=A.|last3=Fukushima|first3=K.|last4=Yotsumoto|first4=H.|last5=Mori|first5=M.|title=Lipoid Pneumonia in Lung Cancer: Radiographic and Pathological Features|journal=Japanese Journal of Clinical Oncology|volume=28|issue=8|year=1998|pages=492–496|issn=0368-2811|doi=10.1093/jjco/28.8.492}}</ref>.
*Poorly differentiated [[adenocarcinoma]] cells secreting [[mucin]] is the most common [[neoplastic]] reason.
**Poorly differentiated [[adenocarcinoma]] cells secreting [[mucin]] is the most common [[neoplastic]] reason.
*Another mechanism suggested is [[Anoxic brain injury|anoxic tissue injury]] stimulating various [[enzymes]] such as [[phospholipase]] and [[Monooxygenase|mono-oxygenases]].<ref name="TakiNakazima1986">{{cite journal|last1=Taki|first1=Takao|last2=Nakazima|first2=Tomoko|last3=Emi|first3=Yohko|last4=Konishi|first4=Yohichi|last5=Hayashi|first5=Akira|last6=Matsumoto|first6=Makoto|title=Accumulation of surfactant phospholipids in lipid pneumonia induced with methylnaphthalene|journal=Lipids|volume=21|issue=9|year=1986|pages=548–552|issn=0024-4201|doi=10.1007/BF02534050}}</ref><ref name="pmid8509711">{{cite journal| author=Evans AJ, Sawyez CG, Wolfe BM, Connelly PW, Maguire GF, Huff MW| title=Evidence that cholesteryl ester and triglyceride accumulation in J774 macrophages induced by very low density lipoprotein subfractions occurs by different mechanisms. | journal=J Lipid Res | year= 1993 | volume= 34 | issue= 5 | pages= 703-17 | pmid=8509711 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8509711  }}</ref><ref name="TölleKolleck1997">{{cite journal|last1=Tölle|first1=Angelika|last2=Kolleck|first2=Ingrid|last3=Schlame|first3=Michael|last4=Wauer|first4=Roland|last5=Stevens|first5=Paul A.|last6=Rüstow|first6=Bernd|title=Effect of hyperoxia on the composition of the alveolar surfactant and the turnover of surfactant phospholipids, cholesterol, plasmalogens and vitamin E|journal=Biochimica et Biophysica Acta (BBA) - Lipids and Lipid Metabolism|volume=1346|issue=2|year=1997|pages=198–204|issn=00052760|doi=10.1016/S0005-2760(97)00036-2}}</ref>
**Another mechanism suggested is [[Anoxic brain injury|anoxic tissue injury]] stimulating various [[enzymes]] such as [[phospholipase]] and [[Monooxygenase|mono-oxygenases]]<ref name="TakiNakazima1986">{{cite journal|last1=Taki|first1=Takao|last2=Nakazima|first2=Tomoko|last3=Emi|first3=Yohko|last4=Konishi|first4=Yohichi|last5=Hayashi|first5=Akira|last6=Matsumoto|first6=Makoto|title=Accumulation of surfactant phospholipids in lipid pneumonia induced with methylnaphthalene|journal=Lipids|volume=21|issue=9|year=1986|pages=548–552|issn=0024-4201|doi=10.1007/BF02534050}}</ref><ref name="pmid8509711">{{cite journal| author=Evans AJ, Sawyez CG, Wolfe BM, Connelly PW, Maguire GF, Huff MW| title=Evidence that cholesteryl ester and triglyceride accumulation in J774 macrophages induced by very low density lipoprotein subfractions occurs by different mechanisms. | journal=J Lipid Res | year= 1993 | volume= 34 | issue= 5 | pages= 703-17 | pmid=8509711 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8509711  }}</ref><ref name="TölleKolleck1997">{{cite journal|last1=Tölle|first1=Angelika|last2=Kolleck|first2=Ingrid|last3=Schlame|first3=Michael|last4=Wauer|first4=Roland|last5=Stevens|first5=Paul A.|last6=Rüstow|first6=Bernd|title=Effect of hyperoxia on the composition of the alveolar surfactant and the turnover of surfactant phospholipids, cholesterol, plasmalogens and vitamin E|journal=Biochimica et Biophysica Acta (BBA) - Lipids and Lipid Metabolism|volume=1346|issue=2|year=1997|pages=198–204|issn=00052760|doi=10.1016/S0005-2760(97)00036-2}}</ref>.
*These enzymes activation in turn cause modification of [[LDL cholesterol]], enhancing [[lipid]] uptake by [[alveolar]] [[macrophages]] similar to [[atherogenesis]].
**These enzymes activation in turn cause modification of [[LDL cholesterol]], enhancing [[lipid]] uptake by [[alveolar]] [[macrophages]] similar to [[atherogenesis]].


*[[Infection]] changes to endogenous [[lipid pneumonia]] is generally localized in airways because the souronding [[lung]] is already consolidated, limiting the spread of bacteria<ref name="BurkeFraser19882">{{cite journal|last1=Burke|first1=M|last2=Fraser|first2=R|title=Obstructive pneumonitis: a pathologic and pathogenetic reappraisal.|journal=Radiology|volume=166|issue=3|year=1988|pages=699–704|issn=0033-8419|doi=10.1148/radiology.166.3.3340764}}</ref>.<br />
[[Infection]] changes to endogenous [[lipid pneumonia]] is generally localized in airways because the souronding [[lung]] is already consolidated, limiting the spread of bacteria.<ref name="BurkeFraser19882">{{cite journal|last1=Burke|first1=M|last2=Fraser|first2=R|title=Obstructive pneumonitis: a pathologic and pathogenetic reappraisal.|journal=Radiology|volume=166|issue=3|year=1988|pages=699–704|issn=0033-8419|doi=10.1148/radiology.166.3.3340764}}</ref><br />


==Genetics==
==Genetics==
Line 58: Line 55:
*Long lasting pulmonary [[granulomatosis]] diseases is associated with endogenous [[Lipoid pneumonia|lipid pneumonia]].
*Long lasting pulmonary [[granulomatosis]] diseases is associated with endogenous [[Lipoid pneumonia|lipid pneumonia]].
==Gross Pathology==
==Gross Pathology==
* well circumscribed, firm with prominent [[lymphatics]] on lung surface in exogenous type.<ref name="urlPathology Outlines - Lipoid pneumonia2">{{cite web |url=http://www.pathologyoutlines.com/topic/lungnontumorlipoidpneumonia.html |title=Pathology Outlines - Lipoid pneumonia |format= |work= |accessdate=}}</ref>
* Well circumscribed, firm with prominent [[lymphatics]] on lung surface in exogenous type.<ref name="urlPathology Outlines - Lipoid pneumonia2">{{cite web |url=http://www.pathologyoutlines.com/topic/lungnontumorlipoidpneumonia.html |title=Pathology Outlines - Lipoid pneumonia |format= |work= |accessdate=}}</ref>
*[[Parenchyma|Parenchymal]] consolidation in endogenous [[lipoid pneumonia]] produce a characteristic yellowish discoloration, hence called "golden pneumonia".<ref name="GaerteMeyer2002">{{cite journal|last1=Gaerte|first1=Scott C.|last2=Meyer|first2=Cristopher A.|last3=Winer-Muram|first3=Helen T.|last4=Tarver|first4=Robert D.|last5=Conces|first5=Dewey J.|title=Fat-containing Lesions of the Chest|journal=RadioGraphics|volume=22|issue=suppl_1|year=2002|pages=S61–S78|issn=0271-5333|doi=10.1148/radiographics.22.suppl_1.g02oc08s61}}</ref>
*[[Parenchyma|Parenchymal]] consolidation in endogenous [[lipoid pneumonia]] produce a characteristic yellowish discoloration, hence called "golden pneumonia".<ref name="GaerteMeyer2002">{{cite journal|last1=Gaerte|first1=Scott C.|last2=Meyer|first2=Cristopher A.|last3=Winer-Muram|first3=Helen T.|last4=Tarver|first4=Robert D.|last5=Conces|first5=Dewey J.|title=Fat-containing Lesions of the Chest|journal=RadioGraphics|volume=22|issue=suppl_1|year=2002|pages=S61–S78|issn=0271-5333|doi=10.1148/radiographics.22.suppl_1.g02oc08s61}}</ref>
[[File:LUNG026.jpg|center|700ptx|thumbnail|Golden pneumonia seen in endogenous lipid pneumonia<ref name="urlPulmonary Pathology">{{cite web |url=https://webpath.med.utah.edu/LUNGHTML/LUNG026.html |title=Pulmonary Pathology |format= |work= |accessdate=}}</ref>]]
[[File:LUNG026.jpg|center|700ptx|thumbnail|Golden pneumonia seen in endogenous lipid pneumonia<ref name="urlPulmonary Pathology">{{cite web |url=https://webpath.med.utah.edu/LUNGHTML/LUNG026.html |title=Pulmonary Pathology |format= |work= |accessdate=}}</ref>]]
Line 64: Line 61:
* Lipoid material (or empty spaces), [[inflammatory cells]] and young [[Fibroblast|fibroblasts]].<ref name="urlPathology Outlines - Lipoid pneumonia">{{cite web |url=http://www.pathologyoutlines.com/topic/lungnontumorlipoidpneumonia.html |title=Pathology Outlines - Lipoid pneumonia |format= |work= |accessdate=}}</ref>
* Lipoid material (or empty spaces), [[inflammatory cells]] and young [[Fibroblast|fibroblasts]].<ref name="urlPathology Outlines - Lipoid pneumonia">{{cite web |url=http://www.pathologyoutlines.com/topic/lungnontumorlipoidpneumonia.html |title=Pathology Outlines - Lipoid pneumonia |format= |work= |accessdate=}}</ref>
*[[Endarteritis obliterans|Reactive endarteritis]], marked alveolar lining cell [[hyperplasia]].
*[[Endarteritis obliterans|Reactive endarteritis]], marked alveolar lining cell [[hyperplasia]].
* lipid-laden foamy [[Macrophage|macrophages]]
* Lipid-laden foamy [[Macrophage|macrophages]]


[[File:PMC5356983 1348-9585-58-482-g004.png|center|700ptx|thumbnail|a) Lipid-laden macrophages with Gram staining in sputum.(b) Lipid-laden macrophages with Giemsa staining in sputum. (c) Lipid-laden macrophages with Giemsa staining in bronchoalveolar lavage fluid. (d) Lipid-laden macrophages with Sudan red staining in bronchoalveolar lavage fluid. (e) Diffuse mucosal hyperemia is visible in the upper or lower lobe bronchus. (f) Widened alveolar space, cell reaction, and localized fibrosis in lung tissues. A tissue biopsy sample was stained using hematoxylin and eosin.<ref name="HanLiu2016">{{cite journal|last1=Han|first1=Chenghong|last2=Liu|first2=Lihai|last3=Du|first3=Shiping|last4=Mei|first4=Jianhua|last5=Huang|first5=Ling|last6=Chen|first6=Min|last7=Lei|first7=Yongliang|last8=Qian|first8=Junwen|last9=Luo|first9=Jianyong|last10=Zhang|first10=Meibian|title=Investigation of rare chronic lipoid pneumonia associated with occupational exposure to paraffin aerosol|journal=Journal of Occupational Health|volume=58|issue=5|year=2016|pages=482–488|issn=1341-9145|doi=10.1539/joh.16-0096-CS}}</ref>]]
[[File:PMC5356983 1348-9585-58-482-g004.png|center|700ptx|thumbnail|a) Lipid-laden macrophages with Gram staining in sputum.(b) Lipid-laden macrophages with Giemsa staining in sputum. (c) Lipid-laden macrophages with Giemsa staining in bronchoalveolar lavage fluid. (d) Lipid-laden macrophages with Sudan red staining in bronchoalveolar lavage fluid. (e) Diffuse mucosal hyperemia is visible in the upper or lower lobe bronchus. (f) Widened alveolar space, cell reaction, and localized fibrosis in lung tissues. A tissue biopsy sample was stained using hematoxylin and eosin.<ref name="HanLiu2016">{{cite journal|last1=Han|first1=Chenghong|last2=Liu|first2=Lihai|last3=Du|first3=Shiping|last4=Mei|first4=Jianhua|last5=Huang|first5=Ling|last6=Chen|first6=Min|last7=Lei|first7=Yongliang|last8=Qian|first8=Junwen|last9=Luo|first9=Jianyong|last10=Zhang|first10=Meibian|title=Investigation of rare chronic lipoid pneumonia associated with occupational exposure to paraffin aerosol|journal=Journal of Occupational Health|volume=58|issue=5|year=2016|pages=482–488|issn=1341-9145|doi=10.1539/joh.16-0096-CS}}</ref>]]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ramyar Ghandriz MD[2]

Overview

lipoid pneumonia parthenogenesis is different in its two sub-types: Exegenous form:it is understood that exogenus lipoid pneumonia is the result of chronic body reaction to fatty substance in the alveol. Lipid reaches alveoli by aspiration or inhalation. Some mineral oils can cause lung injuries such as gasoline. Mineral oils can enter the tracheobronchial tree without causing cough reflex which will bother mucociliary transport system chronically. Injected lipids mechanism of further producing lipid pneumonia is more complicated. As the lipid goes inside the alveoli, it is trapped and hard to expectorate, this condition may be worsen by associated neurological and gastrointestinal disorders affecting swallowing or cough. Lipids in alveoli form emulsion and then consumed by macrophages via phagocytosis. Since the alveolar macrophages cannot metabolize consumed fatty substance, oil is repeatedly released into alveoli after death of these macrophages. The oil released, illicits a giant-cell granulomatosis reaction. Endogenous form: The pathogenesis of endogenous lipoid pneumonia is still not well understood however there are plenty of suggested mechanisms, endogenous lipoid pneumonia can be caused by transbronchial dissemination of cancer cell breakdown products. Poorly differentiated adenocarcinoma cells secreting mucin is the most common neoplastic reason. Another mechanism suggested is anoxic tissue injury stimulating various enzymes such as phospholipase and mono-oxygenases.Infection changes to endogenous lipid pneumonia is generally localized in airways because the souronding lung is already consolidated, limiting the spread of bacteria. On gross and microscopic histology well circumscribed, firm with prominent lymphatics on lung surface in exogenous typelipoid material (or empty spaces), inflammatory cells and young fibroblasts. Reactive endarteritis, marked alveolar lining cell hyperplasia. Lipid-laden foamy macrophages are seen.

Pathophysiology

Exogenous lipoid pneumonia

The important pathophysiology aspects regarding expgenous lipoid pneumonia include:[1][2]

Endogenous lipoid pneumonia

The pathogenesis of endogenous lipoid pneumonia is still not well understood however there are plenty of suggested mechanisms:[3][4][5]

Infection changes to endogenous lipid pneumonia is generally localized in airways because the souronding lung is already consolidated, limiting the spread of bacteria.[10]

Genetics

There is no genetic predisposition reported with lipoid pneumonia.

Associated Conditions

Gross Pathology

  • Well circumscribed, firm with prominent lymphatics on lung surface in exogenous type.[11]
  • Parenchymal consolidation in endogenous lipoid pneumonia produce a characteristic yellowish discoloration, hence called "golden pneumonia".[12]
Golden pneumonia seen in endogenous lipid pneumonia[13]

Microscopic Pathology

a) Lipid-laden macrophages with Gram staining in sputum.(b) Lipid-laden macrophages with Giemsa staining in sputum. (c) Lipid-laden macrophages with Giemsa staining in bronchoalveolar lavage fluid. (d) Lipid-laden macrophages with Sudan red staining in bronchoalveolar lavage fluid. (e) Diffuse mucosal hyperemia is visible in the upper or lower lobe bronchus. (f) Widened alveolar space, cell reaction, and localized fibrosis in lung tissues. A tissue biopsy sample was stained using hematoxylin and eosin.[15]


References

  1. Guerguerian, Anne-Marie; Lacroix, Jacques (2000). "Pulmonary injury after intravenous hydrocarbon injection". Paediatrics & Child Health. 5 (8): 471–472. doi:10.1093/pch/5.8.471. ISSN 1205-7088.
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