Search

A nationwide retrospective study of exogenous lipid pneumonia (ELP) was carried out to update the data on this disease, with emphasis on thoracic computed tomography (CT) scan and bronchoalveolar lavage (BAL) findings. The inclusion criteria were: 1) presence of abnormal imaging features compatible with the diagnosis of ELP; 2) presence of intrapulmonary lipids; and 3) exogenous origin of the lipid pneumonia. Forty four cases were included (20 males and 24 females; mean age 62 +/- 11 yrs), of which four were occupational (chronic inhalation of cutting mist or oily vapour in an industrial environment). Thirty of the 40 nonoccupational cases were related to aspiration of liquid paraffin used for the treatment of constipation. A condition possibly favouring oil aspiration or inhalation was present in 34 patients (77%), most commonly gastro-oesophageal reflux (n = 20) and neurological or psychiatric illness (n = 14). Fever (39%), weight loss (34%), cough (64%), dyspnoea (50%) and crepitations (45%) were the most frequent symptoms. BAL was performed in 39 cases: 23% had a lymphocytic alveolitis; 14% neutrophilic alveolitis; and 31% a mixed alveolitis (lymphocytic and neutrophilic). Alveolar consolidations (57%), ground glass opacities (39%), and alveolar nodules (23%) were the most common radiological abnormalities. The changes were bilateral (79%), predominant in the posterior and lower zones of the lobes concerned (74%), hypodense (71%), and spared the subpleural zones (52%). In 13 cases, hypodensity was retrospectively established on CT scan by the presence of a "positive angiogram". This sign may be of diagnostic value when the density measurement is either not possible or not reliable. In conclusion, this study provides an update of the clinical, biological and radiological profile of exogenous lipid pneumonia and, in particular, confirms the diagnostic benefit of computed tomography scan, which revealed bilateral and hypodense changes in a large majority of cases.

Summary Background Organising pneumonia is a pulmonary disease with variable clinical and radiological features and with many differential diagnoses. Diagnosis is based on histology obtained by either transbronchial or surgical lung biopsy but these techniques have several disadvantages. The aim of this study was to evaluate the diagnostic yield of CT-guided transthoracic lung biopsy in organising pneumonia and to compare it to the usual diagnostic tools. Methods Six cases of organising pneumonia diagnosed with CT-guided lung biopsy are reported and discussed. The role of CT-guided lung biopsy in the diagnosis of organising pneumonia was also reviewed in the literature. Results CT-guided transthoracic lung biopsies provided a higher rate of adequate samples than transbronchial biopsies (92–100% versus 77–86%). The samples were larger, which reduced the risks of misdiagnosis and increased the diagnostic yield (88–97% versus 26–55% in pulmonary nodules and 42–100% versus 66–75% in diffuse pulmonary disease). Complications were rare and generally not serious. Conclusion CT-guided transthoracic lung biopsy may be considered in place of transbronchial biopsy in the diagnosis of organising pneumonia. Surgical lung biopsy remains the gold standard method for diagnosis.

Organizing pneumonia is a pulmonary disease with variable clinical and radiological features and with many differential diagnoses. Diagnosis is based on histology obtained by either transbronchial or surgical lung biopsy but these techniques have several disadvantages. The aim of this study was to evaluate the diagnostic yield of CT-guided transthoracic lung biopsy in organizing pneumonia and to compare it to the usual diagnostic tools.Six cases of organizing pneumonia diagnosed with CT-guided lung biopsy are reported and discussed. A review of literature concerning the role of CT-guided lung biopsy in the diagnosis of organizing pneumonia was performed.CT-guided transthoracic lung biopsies provided a higher rate of adequate samples than transbronchial biopsies (92-100% versus 77-86%). The samples were larger, which reduced the risks of misdiagnosis and increased the diagnostic yield (88-97% versus 26-55% in pulmonary nodules and 42-100% versus 66-75% in diffuse pulmonary disease). Complications were rare and generally not serious.CT-guided transthoracic lung biopsy may be considered in place of transbronchial biopsy in the diagnosis of organizing pneumonia. Surgical lung biopsy remains the reference method for diagnosis.

Pulmonary involvement observed during atheroem- catheter was inserted. bolic disease is usually due to congestive heart failure Ten days after admission the patient became dysand not to pulmonary cholesterol crystal emboli. Very pnoeic. He was able to lie flat and had no peripheral few cases of biopsy-proven specific pulmonary involve- oedema, fever, sweats, chills, or cough. Inspiratory ment have previously been reported in the course of crackles were heard over the lower one-third of both atheroembolic disease [3,4]. We describe a case of lungs. Echocardiography was normal. Arterial-blood atheroembolic disease associated with endogenous gases were the following while breathing oxygen at 6 lipoid pneumonia. Because spumous macrophages are litres per minute: partial pressure of oxygen, 8 kPa; observed in the inflammatory reaction surrounding partial pressure of dioxide 4.5 kPa; pH 7.35. A radiocholesterol crystal clefts in diVerent sites, we hypothet- graph of the chest showed bilateral infiltrates more ize that their presence in brochoalveolar fluid may prominent in right mid- and lower lung fields. reflect the presence of cholesterol crystal emboli in the Computed tomography revealed extensive bilateral pulmonary parenchyma. infiltrates. Flexible fibreoptic bronchoscopy examination did not reveal endobronchial lesion. A bronchoalveolar lavage was performed. Bronchoalveolar fluid

We report the results of a morphological analysis of 60 pulmonary biopsies gathered from a multi center study, organised by the clinico-pathological research group on Wegener's Disease under the auspices of the French Language Society of Thoracic Medicine. Forty of the sixty cases analysed were retained after indexing the histological aspects in order to specify their diagnostic value. Two groups of lesions were distinguished, which had different significance. Group A: These include the three major diagnostic criteria, which reinforce one another as they associate: 1) The polymorphoneutrophil microabscesses with limited central necrosis or an extended necrosis like the contours of a relief map. 2) An angiitis (arteries, veins, capillaries) with eccentric focal parietal crescent-shaped microabscesses. 3) Polymorphous granulomas with giant cells. Group B: In this group are the minor morphological observations (table II) of a lesser value and significance. 1) Acute or chronic lesions with alveolar haemorrhage, endogenous lipid pneumonia, xanthomatous granulomas, an organising pneumonia with an alveolitis. 2) Bronchial lesions: Bronchitis and necrotising bronchiolitis, which is more rarely follicular. 3) Sero-fibrinous or infiltrative neutrophil pleural lesions with focal microabscesses, elastolysis and elastophagia with giant cells in the elastic lamina. Thirteen cases presented with misleading lesions, which was a possible source of diagnostic error and led to a discussion of several associated disorders (Goodpasture's syndrome, and collagen disorder syndrome) or there may be systemic angiitis (Giant cell or lymphocytic) or also systemic or tissue eosinophilia (Churg-Strauss syndrome, bronchocentric granulomatosis) or necrotising bronchitis (atrophic polychondritis) or other forms of nodular interstitial fibrosis, such as histiocytosis X. We would like to stress the great polymorphic variation of the lesions and the difficulties which confront pathologists in the diagnosis of Wegener's Disease, above all when it is localised to the lung. There is value in finding at least one major diagnostic criteria which is associated with a minor criteria and with the help of the C.ANCA levels may lead to a narrow clinicopathological correlation and allows for a fairly precise approach to the diagnosis and identification of early or unusual lesions and thus to the early treatment of patients before irreversible renal failure appears.

In the case described, the onset of haemoptysis led to the discovery of a rounded opacity at the left base. All investigations being negative, thoracotomy was performed. The diagnosis could then be made by histology. Bronchopulmonary "tumourlets" are rarely seen (184 cases) masses of epithelial cells which are usually discovered by chance within areas of altered pulmonary tissue. Forms with clinical or radiological manifestations are extremely rare, only 4 other cases having been described. The pathogenesis of these tumours has been the object of recent ultrastructural studies which have shown the relationship which exists between "tumourlet" and carcinoid tumour. It would thus seem reasonable to classify "tumourlets" amongst the tumours of the diffuse endocrine system. The authors nevertheless feel that it would be premature to name them as bronchial carcinoids of tumourlet type. The concept of "tumourlet" as a separate entity should be retained.