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Lipoid pneumonia complicated by mycobacteria infection

Case contributed by Dr Luke Danaher

Presentation

General decline and shortness of breath.

Patient Data

Age: 75 years
Gender: Female
  • increased airspace and interstitial opacities bilaterally (left greater than right)
  • consolidation in the left lung
  • multiple air fluid levels in the left side of the anterior mediastinum (see lateral projection)
  • prior esophagectomy with anterior mediastinal pull through
  • interstitial and ground glass opacities in a dependent distribution
  • this gives a characteristic "crazy paving" appearance
  • chronic small left pleural thickening
  • confluent airspace opacities in the LUL, lingula, and LLL

Case Discussion

  • patient had prior esophagectomy which poses an aspiration risk
  • the airspace and interstitial opacities give the "crazy paving" pattern 
  • the differential of chronic crazy paving is limited and includes lipoid pneumonia
  • frank yellow fluid was seen at bronchoscopy and confirmed as lipid on microscopy
  • the more confluent airspace opacities were sampled to exclude malignancy
  • this yielded mycobacteria fortuitum
  • non-tuberculous mycobacteria (NTM) is a known association of lipoid pneumonia
  • it is treated with bactrim
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Case information

rID: 50836
Published: 24th Jan 2017
Last edited: 1st Nov 2020
System: Chest
Inclusion in quiz mode: Included

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