Correct!
5. The patient admits to taking mineral oil for constipation

The patient admitted to nightly use of mineral oil in the attempt to relieve constipation. Aspiration of inert oily substances, such as mineral oil, may result in accumulation of the oil in the lung parenchyma, which can be detected as fatty attenuation consolidation at thoracic CT, enabling the diagnosis of lipoid pneumonia. The CT appearance in this case is not suggestive of hypersensitivity pneumonitis, and therefore the history of owning African grey birds is not the best answer. Similarly the history of injection drug use would suggest either septic embolization or opiate-related lung injury, and neither of those choices fits well with the CT findings in this patient. The history of being trapped in a burning house suggests a toxic exposure. Such an exposure may lead to constrictive bronchiolitis months or years later. However, the CT appearance of constrictive bronchiolitis consists of mosaic attenuation on inspiratory imaging and air trapping on expiratory imaging; these findings differ markedly than those found in this patient. Finally, amiodarone pulmonary toxicity may show areas of high attenuation, not low attenuation, in addition to features resembling an idiopathic interstitial pneumonia, such as peripheral nodular consolidation or peripheral ground-glass opacity and reticulation.).

Diagnosis:  Lipoid pneumonia

References

  1. Lee JS, Im JG, Song KS, Seo JB, Lim TH. Exogenous lipoid pneumonia: high-resolution CT findings. Eur Radiol 1999; 9(2):287-291. Seo, JB, Im JG, Kim WS, et al. Shark liver oil-induced lipoid pneumonia in pigs: correlation of thin-section CT and histopathologic findings. Radiology. 1999;212(1):88-96.
  2. Betancourt SL, Martinez-Jimenez S, Rossi SE, et al. Lipoid pneumonia: spectrum of clinical and radiologic manifestations. AJR Am J Roentgenol 2010;194(1):103-109. [CrossRef] [PubMed]
  3. Annobil SH, el Tahir M, Kameswaran M, Morad N. Olive oil aspiration pneumonia (lipoid) in children. Tropical medicine & international health : TM & IH. 1997;2(4):383-388. [CrossRef]
  4. Franquet T, Gimenez A, Bordes R, Rodriguez-Arias JM, Castella J. The crazy-paving pattern in exogenous lipoid pneumonia: CT-pathologic correlation. AJR Am J Roentgenol. 1998;170(2):315-317. [CrossRef] [PubMed] 
  5. Baron SE, Haramati LB, Rivera VT. Radiological and clinical findings in acute and chronic exogenous lipoid pneumonia. J Thorac Imag. 2003;18(4):217-224. [CrossRef]
  6. Annobil SH, el Tahir M, Kameswaran M, Morad N. Olive oil aspiration pneumonia (lipoid) in children. Tropical medicine & international health : TM & IH. 1997;2(4):383-388. [CrossRef] 
  7. Zanetti G, Marchiori E, Gasparetto TD, Escuissato DL, Soares Souza A, Jr. Lipoid pneumonia in children following aspiration of mineral oil used in the treatment of constipation: high-resolution CT findings in 17 patients. Pediat Radiology. 2007;37(11):1135-1139. [CrossRef] [PubMed] 
  8. Annobil SH, Ogunbiyi AO, Benjamin B. Chest radiographic findings in childhood lipoid pneumonia following aspiration of animal fat. Eur J Radiol. 1993;16(3):217-220. [CrossRef]

Home/Imaging