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2 October 2013 - Case of the Week #287

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Case of the Week #287

Clinical History:
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.

Micro images:

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.

The differential diagnosis of pulmonary granulomatous inflammation is broad (Ann Diagn Pathol 2003;7:127, Histopathology 2007;50:289), and requires special stains, culture and clinical correlation.

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
PathologyOutlines.com, Inc.
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Telephone: 248/646-0325
Email: NatPernick@Hotmail.com
Alternate email: NatPernick@gmail.com