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We evaluated cells and lipids recovered in the bronchoalveolar lavage fluid from seven patients with liquid paraffin pneumonitis. For each patient, the BALF was whitish with oil droplets on the surface. Alveolar macrophages contained numerous, large vacuoles that did not react with May-Grunwald-Giemsa, Papanicolaou, or periodic acid-Schiff but were stained in black with Sudan B, orange with Sudan III and red with oil Red O. Liquid paraffin was identified on thin layer chromatography of BALF-extracted lipids as a very hydrophobic compound migrating on the solvent front as control liquid paraffin. This abnormal spot was definitely identified as liquid paraffin by infrared spectroscopy and gas liquid chromatography for the first patient. The number and percentage of AMs were largely decreased in the BALF of each patient, whereas the number of neutrophils, eosinophils and lymphocytes was increased. These findings suggest that this cell-mediated inflammatory response plays a role in the development of interstitial fibrosis at late stages of liquid paraffin pneumonitis.

Lipid analyses of the bronchoalveolar washing fluid of three patients affected with chronic unidentified pneumonia showed the presence of a major hydrophobic compound identified as paraffin oil by thin layer chromatography, infrared spectroscopy and gas liquid chromatography (by comparison with various paraffin preparations as standards). Moreover the phospholipid and neutral lipid composition was determined. In conclusion, the usefulness of bronchoalveolar lavage and its biochemical analysis is discussed as a non-invasive method of diagnosis and therapeutic approach to liquid paraffin pneumonia (in the cases herein described, between 100 and 500 mg of paraffin oil were extracted from 100 ml of bronchoalveolar washing fluid.

A case report of a diffuse alveolar lipoid pneumonia occurring in a patient incapable of giving a proper history underlines the diagnostic difficulty of lipoid pneumonias. Till now, unless the diagnosis was made at necropsy, one relied on a history of prolonged consumption of medications containing mineral oil, with evidence on open lung biopsy of excess fatty material in the pulmonary parenchyma. Chromatography on thin slices of the lipid extract of bronchiolo-alveolar lavage liquid fixed in silica gel, a simple technique, should rapidly give the diagnosis. In the alveolar form of the disease bronchopulmonary lavage returns a significant quantity of paraffin oil and may be considered as a therapeutic method.

Four cases of interstitial lung disease caused by chronic inhalation of paraffin oil are reported. The disease is facilitated by disorders of deglutition or gastro-oesophageal reflux. The diagnosis is confirmed by chromatography on a thin slice of silica gel of the lipid extract of broncho-alveolar lavage fluid.

28 patients presenting with proven pleuro-pulmonary pathology due to asbestos underwent conventional radiography and also computed tomography (TDM). It is evident that TDM was more sensitive in detecting the presence of pleural plaques which were either hidden or invisible on standard radiographs. False parietal images were often eliminated. With a mesothelioma it can guide the biopsy approach and by visualising contra-lateral plaques that the origin is asbestos. It should enable irregular plaques to be monitored more easily.

Results of computed tomography and conventional radiology were compared during investigation of 17 patients with pleuropulmonary lesions from confirmed asbestosis. Computed tomography images appeared to provide improved data for detection and analysis of pleural plaques, particularly in the costovertebral grooves; false pleural images (associated shadows, fatty tissue) can be eliminated. The CT scan should occupy a place of choice for surveillance of subjects in contact with asbestos and presenting pleural anomalies.

A series of 125 CT-guided thoracic punctures performed over a 20-month period is reported. The only complications were pneumothorax in 14 cases, 5 of which were drained, and 1 case of hemomediastinum. For the diagnosis of malignancy the sensitivity of the method was 82%, its specificity 100% and its effectiveness 74%. The level of sensitivity rose to 86% in the last 90 cases. This method is an additional contribution to exploration of the lungs. In trained hands it gives rise to few complications and should result in a histological diagnosis in a large number of cases.

Interstitial pulmonary calcinosis was discovered after finding hypercalcaemia in a man of 56 who had been treated for several months with Hydrochlorthiazide. This was a secondary hyperparathyroidism due to the formation of parathyroid adenomatous cysts. This illness had been quiescent until then and was probably revealed as a result of the hydrochlorthiazide therapy.