017. Exogenous acute lipoid pneumonitis from animal fat aspiration (part of intestine)
Dimitra Gkika1, Emmanouil Manos1, Dimitrios Kolovos1, Vassiliki Batsouli1, Eirini Pathiaki2, Evagelia Mavromati2, Smaroula Divani3, Anna Vardouli3, Angelos Panagopoulos4, Konstantinos Karkanis1, Jacob Angel5
Objective: In the aspiration of animal fats, bronchoscopy is promptly necessary, not only for removing the foreign body but also for its therapeutic importance in order to avoid severe lipoid pneumonia, because fat acids are very toxic for the bronchial mucosa.
Methods: Patient 84 years old, nonsmoker, with a medical history of heart disease under acenocoumarol, referred accidental aspiration of cooked animal intestine, 12 hours ago, with rough cough and dyspnea that started instantly. To be noted, the patient presented with wheezing in both lungs. Thoracic CT scan images reveal a suspicion of aspiration, confirmed by indirectly evidence (right middle lobe atelectasis and also mediastinum transposition to the left and consolidation with atelectasis in the left lower lobe, as evidence of previous infections-possible aspirations, emerged from his case story). Therefore, urgent bronchoscopy was performed and the foreign body, that was movable with the cough, was removed. Bronchial lavage was performed due to acute infection in whole bronchial tree. A reactive granuloma tissue was noted in the entrance of the middle lobe, but because of the anticoagulant intake biopsy wasn’t performed. During his hospitalization the patient was under antibiotics, bronchodilators and corticosteroids.
Results: At the time of revaluation, two weeks after, the patient was non symptomatic while the new CT scan showed evidence of residual infection in the left lung and atelectasis of the right middle lobe on the left. Bronchoscopy was reperformed and biopsy was taken in the entrance of the right middle lobe because of the noted reactive granuloma tissue, seen at the first bronchoscopy. No signs of bronchial inflammation were found (impressive improvement due to immediate intervention).
Conclusions: Animal fat aspiration causes acute bronchial inflammation and therefore, lipoid pneumonia within a few hours, due to rapid hydrolysis of releasing fatty acids. Removing the animal fat with the bronchoscopy and performing bronchial lavage, helped instantly the clinical improvement of the patient and more important guided to the avoidance of severe complications.
Keywords: Fat embolism; pneumonitis; aspiration
doi: 10.3978/j.issn.2072-1439.2015.AB017
