Welcome to Pulmonology Consultant's latest interactive diagnostic quiz. Over the next few pages, we'll present a case and ask you to make the diagnosis. Along the way, we'll provide details about the case, and at the end, we'll share the patient's diagnosis.

Ready to get started? >>

First, let’s meet the patient…

A 7-week-old girl presented with the parents’ chief concern of fussiness. The physical examination revealed a well-appearing infant. Abdominal radiographs showed a nonspecific bowel gas pattern, along with an incidental finding of opacities in both lower lungs (A).

Are you correct? >>

Answer: Chest radiograph and computed tomography scan

Chest radiographs and a follow-up chest computed tomography scan revealed patchy, bilateral alveolar infiltrates. The infant’s lungs demonstrated abnormal multifocal airspace opacifications of the right upper lobe, the right middle lobe, and the medial lower lobes bilaterally, in subsegmental distribution (B).

Take a look at scans C and D:

Are you correct? >>

Answer: Yes

Patchy alveolar infiltrates were visible diffusely throughout both lungs, with relative sparing of the left upper and right middle lobes on scans C and D.

A more extensive history revealed that the parents had been feeding the infant 15 to 30 mL of olive oil daily for constipation. 

Are you correct? >>

Answer: Lipoid pneumonia

The patient received a diagnosis of lipoid pneumonia secondary to aspiration of olive oil.

The differential diagnosis of diffuse infiltrates on chest imaging of a neonate includes bronchopulmonary dysplasia, neonatal lung disease (eg, interstitial lung disease), aspiration syndromes, and congenital heart defects.

Are you correct? >>

Answer: All of the above

Making the unusual diagnosis of lipoid pneumonia secondary to aspiration of oil can be difficult because symptoms, signs, and radiographic findings are nonspecific. Aspiration may not be obvious, because oil may not trigger a cough reflex.

Authors:

Jonathan Popler, MD

Georgia Pediatric Pulmonology Associates, Atlanta, Georgia

Ann Beach, MD

Scottish Rite Pediatric and Adolescent Consultants, Children’s Healthcare of Atlanta, Georgia

To read the full case report, see:

Popler J, Beach A. Lipoid pneumonia. Consultant for Pediatricians. 2015;14(7):334. https://www.consultant360.com/articles/lipoid-pneumonia.