False positive 18FDG PET-CT results due to exogenous lipoid pneumonia secondary to oily drug inhalation: A case report.

RATIONALE: Exogenous lipoid pneumonia is a rare condition due to abnormal presence of oily substances in the lungs. It is a rarely known cause for false positive FDG PET-CT results and can sometimes lead to invasive investigations. Searching and finding the source of the oily substance is one of the keys to the diagnosis. Inhalation of oily drugs during snorting has rarely been described. PATIENT CONCERNS: A patient with well controlled HIV infection was referred for an FDG PET-CT to assess extension of Kaposi's disease, recently removed from his right foot. The patient had no particular symptoms. DIAGNOSES: Abnormal uptake of FDG was found in a suspicious lung nodule. An experienced radiologist thought the nodule was due to lipoid pneumonia. INTERVENTIONS: Bronchoalveolar lavage fluid did not contain lipid-laden macrophages but bronchoscopy showed violet lesions resembling Kaposi's disease lesions. Lobectomy was performed after a multidisciplinary discussion. OUTCOMES: Anatomopathological analysis revealed the nodule was due to lipoid pneumonia. The patient's quality of life did not diminish after the operation and he is still in good health. The source of the oily substance causing lipoid pneumonia was found after the surgery: the patient used to snort oily drugs. LESSONS: The presence of a suspicious lung nodule possibly due to lipoid pneumonia in a patient with known Kaposi's disease was difficult to untangle and lead to invasive surgery. It is possible that if a source of exogenous lipoid pneumonia had been found beforehand, surgery could have been prevented.

Neumonía lipoidea exógena en pacientes laringectomizados: ¿es el patrón de opacificación en vidrio esmerilado/en empedrado una reacción organizada de la neumonía capaz de predecir una mala evolución? / Exogenous lipoid pneumonia in laryngectomy patients: Is ground glass opacity/crazy paving pattern an organizing pneumonia reaction that can predict poor outcome?

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Exogenous lipoid pneumonia (oil granulomas of the lung).

The authors observed three cases of exogenous lipid pneumonia clinically suspected of lung carcinoma. Histological examination of material after thoracotomy gave the possibility of correct diagnosis. The lesions in lungs were characteristic granulomas around lipid material and with surrounding advanced fibrosis.

[Pseudotumoral lipid pneumopathies. Apropos of six cases]. / Pneumopathies lipidiques pseudo-tumorales. A propos de six observations.

In cases of localised pneumonia due to oil aspiration, the diagnosis may be difficult and is often assessed by thoracotomy. Six cases of lung paraffinoma are reported. The lesion, localised in the lower lobe in five patients out of six, was discovered on screening chest x-rays. In two cases, two lesions were observed in the same patient. All six patients underwent lung resection. Diagnosis was made on histologic examination showing foreign body reactions against oil. Oil aspiration was due to oily nose drops in one patient and to the use of paraffin oil on a tracheostomy in two others. The preoperative diagnosis may be suspected on bronchial lavage CT scan and MRI. When the diagnosis is strongly suspected, thoracotomy can be avoided as in some cases withdrawal of the medication can be followed by progressive resolution of the radiological signs.