대 한 방 사 선 의 학 회 지 1991 ; 27 (5) : 644~646

Journal of Korean Rad iological Society, September, 1991

Exogenous Lipoid Pneumonia after Ingestion of Shark Liver Oil: A Case Report

Jae Bum Yang, M.D. , Hyeon Lim Seong M.D. , Chan Sup Park, M.D.* , Yang Hee Park , M.D. , Sang Sun Lee, M.D.

Department o[ Radiology, National Police Hospital

Exogenous lipoid pneumonia was first described in 1925 by Laughlen and a sizeble literature developed. reaching

a peak in the 1940s. Two cases of exogenous lipoid pneumonia in children were reported domestically .

We wish to report a case of exogenous lipoid pneumonia presented with bilateral air-space consolidation in a

53-year-old man who had a long history of ingestion of shark liver oi l. This report describes its radiological findings .

along with a review of the literature.

Index Words: Lung. diease

Lung. CT. 60.1211

Lung. lipoid pneumonia. 60.253

Introduction

Exogenous lipoid pneumonia is an uncommon

disorder at presen t. Exogenous lipoid pneumonia

which results from aspiration of oil presents a difficult

diagnostic problem for both clinic ian and radiologist

because it may mimic many diseases. ln this report ,

lipoid pneumonia was suggested by chest radiograph

and computed tomogram (CT). supported by a long

history of shark liver oil ingestion. The diagnosis was

confirmed by detecting oil droplets in the bronchial

washings .

Case Report

A 53-year-old male was admitted to the National

Police Hospital with fever . left chest pain and cough

for 15 days. He had resituals neural clefiate of cerebral

infarction with left hemiparesis. Physical examina-

visual acuity for two years Laboratory studies

demonstrated anemia (hemoglobin . 10.0 g/dll a nd

leukocytosiS (16.00m/mm) with a lymphocyte count

of 12 "10 . The patient had a history of taking Squalen@

(shark live r oil) for two years

A chest rad iograph demonstrated ill defined

homogen eous haziness with air bronchograms in

both lower lobes (Fig. 1). High resolution CT mainly

showed mixed interstitial reticular density in portions

of both lungs and diffuse air-space consolidations

bilaterally without evidence of bronchial obstruction

(Fig. 2). The density of the lesion was slightly lower

than that muscle

In respiratory secretion , sputum examination

showed nume rous lipoid lad en alveolar

macropharges ofvarying sizes. consistent with lipoid

pneumonia (Fig. 3 ).

Discussion

tion revealed rales on both lower lung fields and Domestically two cases of exogenous lipoid

tongue deviation to the left. represen ting facial palsy. pneumonia in children have been reported by Chang

In addition. he had slurred speech and decreased Gee Gang and Jeong Wan YoO' -2' . A history ofusage

*인하대학교 의과대학 방사선과학교실 *Department of Radiology. lnha University Hospital

이 논문은 1990년 12월 21일 접수하여 1991년 7월 8일에 채택되었음. Received December 2 1. 1990. accepted July 8. 1991

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Jae Bum Yang et al: Ex ogenous Lipoid Pneulllonia after Ingestio n of Shark Liver Oil

Fig. 1. Chest radiograph shows i1l defin ed homogeneous hazines predominen tJy in both lung fi elds with air bron. chograms. And streaky density and calcifications in up. per lobe represen ts inactive pulmonary tuberculosis

Fig. 2. High resolution CT at the level of the inferior pulmonary vein shows diffuse air-space consolidations bilatera1ly and interstitia l infiltrations with reticula r and ground.glass density

of shark live r oil was obta ined a lI

Exogenous lipOid pneumonia is a chronic. ac inar

or interstitia l. proliferative in f1 a mmatory disease

resulting from aspiratio n of o il m ateria l. It has been

encounted in patien ts who use mine ral o il. such as

liquid paraffin for con st ipation and in nose drops ‘

an imal oils. such as cod li ver given to children ‘ and

vege ta bl e o il s. s esa m e oi l used in medica l

suspensions(3.9) . The incidence is high er in older pa.

‘ ‘

•

Fig.3. Smea r of lung sputum cytology shows multiple vacuolated macrophages with fat vacuoles (Papanicolau stain. x400)

tie n ts with unde rlying de bility (l ü)

The m echan ism of oil a spiratio n could be due . to

the inhibitory action of the shark liver oil to stimulate

th e coug h re f1 ex(6). Habi tual consumption be fore

retiring m ay rcsult in pooli ng of the shark live r o il

in the pharynx with subseque n t aspiration during

s leep(4-9). In addition. shark liver oil has been shown

to inhibitc iliary act io n when presen t in large quanti.

ty . w ith resu ltant fa ilure to c lear aspirated material

from the tracheobroncheal tree( 11) . The clinical

presentations range from occasional cough to severe

respiratory difficulties.

The radiolog ic manifestations of exogenous lipoid

pneumonia vary from a sol itary lipoid granuloma or

large consolida tions s imulating carc inoma to an e x .

te nsive bronchopneumonia ( 12) . CT scans can help by

detec ting fat in lung m ass. The typical radiologic fin

dings show a bilatera lIy diffuse pe rihilar or cen tra lIy

ill de fin ed nodu lar or co n f1 u ent a ir.space consolida

tion which is us ua lly more se ve re in the base( 13 .17)

ln most cases lower lobes a re affected. ln debilita ted

pat ie n ts. because of their recumbent positions. in­

volve m ent is likely to occur in the superior s egment

of a lower lobe or th e posterior segment of an upper

lobe( 18 ). Th e di ffe r e ntia l diagnosis of lipoid

pneumonia includes pulmonary edem a . tuberculosis.

bacteria l pneumonia. fungal infection . alve이ar pro.

te inosis. bronchioloa lveolar carcinoma or m etastatic

cancer. pneumOCOl1l0S1S ‘ hypersentitivity pneumoni.

t is a nd pu lmonary fjbrosis . Treatm ent co ns ists of

discontinuing the use of the oppending oil and rare

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Journal 01 Korean Radi ology Society 1991 ; 2 7( 51: 644-646

ly is s urg ical removal necessary( 17). Although past

histor y of ingestion of o ily substance can easily be

forgotten by the patie nts . it is vital to establish the

diagnosis for treatme n t. Exacl diagnosis requires

detec tion of th e oil d r oplets eith e r by spu tum ex­

am ina lion ‘ aspiration biopsy. or b y surgica l

resec tion( 19)

REFERENCES

l 강창기， 김호성 ， 김정탁. 지방성성 폐렴 1 례， 소아과학

학회 1990;33 : 393-397

2 유정환， 박환규， 손영모. 컴퓨터단충촬영으로 진단된

지 방성 폐렴 l 례 . 대한의학협회지 1990; 33 : 921-925

3. Be rg R. Burford TH. Pulmonary para fTi noma (l ipoid

pneumonia ): a critical study . J Thorac Surg. 1950:

20 :4 18-428

4. Borrie cJ. Gwynn e JF. Paraffinoma of lung: Lipoid

pneumonia. Reporl of two cases. Thorax 1973 ‘

28:214-221

5. Ha mplon AO. Bickham CE ‘ 씨linship T . Lipoid

pneumo nia . AJR 1955: 73: 938-949

6. Genereux GP. Lipoid in lu ngs: radiologic-pathologic

corre la tion. J Can Assoc Radiol 19 70 : 21 ‘ 2-15

7. Miller A ‘ Bader RA. Bader ME et a l. Mine ra l oil

pneumonia. Ann Intern Med 1962: 57:627-634

8. Schne ide r L. Pulmonary hazard of th e ingestion of

minera l oil in 버e apparen tly healthy adul t: a clinico­

roen tge nolog ic study. with a re port offive cases . N

Eng J Med 1949: 240:248-29 1

9. Timmerman RJ ‘ Schroe JA . Lipoid pneumonia

〈국문 요약〉

caused by m ete namide mandela te suspension.

JAMA 1973: 225 :1524- 1525

10. Volk B씨1 . Natha nson L. Losner S e t a l. Inc id ence of

lipoid pneumonia in a survery of389 chronically ill

patients. Am J Med 195 1 ‘ 10:3 16-324

1 1. Bishop G Oil asp irat io n pn e umonia a nd

pneumolipidos i. Ann Intern Med 1940 ‘ 23: 13 27-

1359

12. Ke nnedy JD. Castello P. Balikian JP et a l. Ex­

ogenous lipo id pneumo nia . AJR 1940 ‘

136: 11 45-1 149

13. Praka sh UBS. Barha m SS. Carpenter HA et a l

Pu lmonary a lveolar phospholi poprotinosis: ex­

perience with 34 cases 밍ld a review. Mayo Clin Proc

1987: 62:499-518

14. Clagu e HW. Walace AC. Morgan WKC. Pulmona ry

in terstitial fibrosis associated with a lveolar pro­

te inosis. Thorax 1983: 865-866

15. Ra mirez RJ. Pu lmonary a lveola r prote inosis

Ra diology 1969 ‘ 92 :129 1-1295

16. Preger L. Pulmonary a lveolar proteinosis. Radiology

1969 ’ 92:1291-1295

17. Godwin JD. MuJler NL. Takasug i JE . Pulmona ry

a lveola r proteinosis: CT findings Radiology 1988 ‘

169 ’ 609-613

18. Sunber g RH ‘ Kirshner KE ‘ Brown MJ. Evaluation

of li poid pneu monia . Dis c hest 1959: 36:594-60 1

19 . Wheeler PS. Stitik FP. Hutchins GM et a l. Diagnosis

of lipoid pneumonia by computed tomography

JAMA 1981: 245:65-66

스쿠알렌 복용후 발생한 외인성 지방성 페럼

-1 려| 보고-

국립경찰병원 방사선과 인하대학교 의과대학 방사선과학교실*

양재범·성현럼·박찬섭*박양희·이상선

외인성 지방성 폐렴 은 1925년 Laugh len에 의해 처음 보고되었고 1940년대에 활발한 보고가 있었으나 그후 감소하는

추세였다. 국내에서 는 소아 환자에서 2례 보고되었다

저자들은 최 근에 뇌경색에 의한 우측 면마비 상태의 53세 냥자환자가 장기간 액체상태의 스쿠알헨 a (S hark liver

oil ) 복용한 후 방사선학적 양측성 기강 정결 ( air.space consolidation )으로 발현하였으며 기관지경검사에서 지방성

dropl et의 발견으로 지방성 폐렴으로 확진된 l 례 를 경험하였기에 문헌 고찰과 함께 보고하고자 한다

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