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Lipoid pneumonia complicated by mycobacteria infection

Case contributed by Luke Danaher
Diagnosis certain

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 (Sulfamethoxazole-Trimethoprim)

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