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Case of the Week #287
A 71 year old man with recent history of meningitis presented with recurrent episodes of pneumonia. High resolution CT scans showed "crazy paving" and "tree in bud" images. The patient underwent a transbronchial biopsy.
What is your diagnosis?
Aspiration with granulomatous bronchiolitis and lipoid pneumonia
Aspiration of particulate matter, traditionally observed at autopsy, has also been described in debilitated patients, who often have a history of recurrent pneumonia (Am J Surg Pathol 2007;31:752), which is often unrecognized (Am J Surg Pathol 2010;34:1456). It usually (88%) shows bronchiolitis obliterans-organizing pneumonia, often with multinucleated giant cells, acute bronchopneumonia / bronchiolitis, or suppurative granulomas. Foreign material is usually, but not always (Am J Surg Pathol 2011;35:426) present.
Lipoid pneumonia is often an incidental post-mortem finding associated with debilitating disease. The lipid may be exogenous (from nasal sprays or inhalation of other lipid containing substances) or endogenous (bronchial obstruction).
Nat Pernick, M.D., President
and Palak Thakore, Associate Medical Editor
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