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Abstract
Purpose :
The purpose of this study was to describe the thin-section computed tomography (CT) findings and histopathologic findings of squalene aspiration pneumonia.
Materials and Methods :
Thin-section CT scans were obtained from nine patients with proven exogenous lipoid pneumonia resulting from aspiration of squalene(derived from shark liver oil). The condition was diagnosed by biopsy (n=3), bronchoalveolar lavage(n=4), or sputum cytology and clinical history (n=2) å a clinical history of squalene use was confirmed in all patients. Specimens of transbronciiial lung biopsy were also reviewed and compared with thin-section CT findings.
Results :
Thin-section CT findings included ground-glass attenuation(n=8), consolidations obliterating vascular marking(n=4), scattered centrilobular ground-glass attenuation(n=2), and interlobular interstitial thickening(n=6). Geographic lobular distribution with peripheral spared lobules was observed in all patients. These diseases involved multiple lobes (n=5) and abnormalities were usually located in the dependent portion of the lung. In three cases, histopathol- ogical correlation showed that ground-glass attenuation reflected intra-alveolar infiltration of lipid-laden macrophages with exudative fluid. Interlobular septal thickening represented hyperplasia of type Π pneumonocytes with mild fibrosis.
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Fig. 1.
Case 3. A thirty-three year-old man with a history of taking squalene for one month. During the last week, he had taken more than 10 capsules of squalene through the nose, whereupon a cough and mild dyspnea developed. A. On thin-section CT, geographic lobular distribution of dense lobular consolidation obliterating vascular marking was observed at the superior segments of both lobes. An air-bronchogram is clearly demonstrated by the consolidation. Interposed ground-glass attenuation was peripherally located. B. A photomicrograph (Masson-trichrome stain å original magnification, X 200) of a transbronchial lung biopsy specimen obtained two days after the CT scan shows lipid-laden macrophages (arrowheads) and exudative fluid in the alveolar space. There is no demonstrable innltration or inflammatory cells or interstitial fibrosis.
Fig. 2.
Case 4. A fifty-five year-old male with a history of taking squalene for two months. A. Thin-section CT scans of the right lung obtained at the level of the carina. Dense consolidation obliterating bronchovascular marking is located at the posterior segment of the right upper lobe. An air-bronchogram is visualized by the surrounding air space consolidation. Scattered centrilobular ground-glass attenuation (arrows) is also noted in the anterior segment of the right upper lobe. This may have been caused by scattered droplets of squalene. Interstitial thickening is not definite. B. A photomicrograph (Masson-tric- hrome stain å original magnification, X 200) of a transbronchial lung biopsy specimen obtained 14 days after the CT scan of a. Lipid-laden macrophages (arrowheads) is still observed, but exudate is not. Only a small amount of interstitial fibrosis and hyperplasia of type Π pneumonocytes is noted.
Fig. 3.
Case 2. A fifty-nine year-old man with a history of taking squalene for three years. A. Thin-section CT scans of the right lung were obtained at the level of the right middle lobar bronchus. There is geographically distributed interstitial thickening (arrow) at the lateral segment of the right middle lobe. Involved area is sharply marginated from uninvolved normal parenchyma which is located at the peripheral portions of the lung. Interposing ground- glass attenuation is also noted. B. Photomicrograph (Masson-tric- hrome stain å original magnification, X 200) of a transbronchial lung biopsy specimen obtained nine days after the CT scan of a. shows hyperplasia of type Π pneumonocytes and interstitial fibrosis. Lipid-laden macrophages are scarcely observed.
Tabel 1.
Findings in Nine Cases of Squalene Aspiration Pneumonia
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