Since we received little in the way of responses to our mystery quiz, we thought a hint might be in order, so here's the case again this time with a hint. Please submit your answers by clicking on the "comments" link below this post. As always, for those of you who are unwilling to attach your name, you can post your comments anonymously.
The patient is a 77 year old male whose chief complaint was severe left hip pain of five years duration. As part of a preoperative evaluation for hip surgery, a routine chest x-ray was obtained as below. Click on the thumbnails below for full size images:
A prior film done six months previously showed similar but less impressive findings. Upon review, the patient denied any pulmonary symptoms or significant history of smoking. There was no history of pets, occupational exposures, recent travel or illicit drug abuse. His only medication was oxcodone. His review of systems was notable only for chronic constipation.
Chest computed tomography showed the following:
The patient subsequently underwent a bronchoscopy with transbronchial biopsy. The pathology specimens are shown below.
What's your diangosis? Click on the word "comments" below to respond.
9 comments on “Mystery Quiz #2 (with a hint…)”
Lipoid pneumonia from chronic mineral oil ingestion.
lipoid pneumonitis. for your nerves.
squamous cell carcinoma of lung most probably
lipoid pneumonia ( crazy paving pattern with ground glass opacity and interlobular septal thickening in RML and LLL).
Lipoid pneumonia
pneumonia
Lipoid pnuemonia from histology.
There is tracheal shift to the right in the superior mediastinum by a ?lymph node.
CT at that level is not shown.
Agree with MUFADDAL …Lipoid Pneumonia. Clue of chronic constipation may reveal the use of mineral oil ingestion on further questioning. Wonder if the pt also has GERD? Pulmonary pattern tends to be alveolar thoughinterstitial patterns have been recognized.
NO real idea though fairly certain that constipation is due to motility disorder intestinal on the basis of oxycodone. As far as the lung is concerned, perhaps this chap suffers some sort of restrictive lung disease as I understand the drug is a respiratory depressant. What do you expect from a non-doc?
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