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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with great interest the exogenous lipoid pneumonia &#40;ELP&#41; case series from Latorre et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> which elegantly demonstrates the radiological findings inherent to pathological aspiration of petroleum jelly &#40;Vaseline&#41;&#46; The authors report that the most common high-resolution computed tomography &#40;HRCT&#41; findings in ELP are areas of low attenuation and ground glass opacity &#40;GGO&#41;&#46; However&#44; on careful analysis&#44; the CT images for Case 1 exclusively show peribronchial consolidation tissue&#44; but no areas of GGO&#46; The second case reported&#44; supported by CT&#44; CT-PET and MRI&#44; very clearly shows fat in middle lobe&#46; Some of the clinical cases did not have an accompanying radiological image&#46; We respectfully would like to share our experience of two cases of aspiration of oily product&#44; used for cleaning the stoma in adult patients &#40;a 63-year-old woman and a 68-year-old man&#41; after laryngectomy for cancer&#46; Our patients showed an extended GGO component in the middle lobe&#44; lingula and lower lobes&#44; confirmed on bronchoalveolar lavage testing to be alveolar lipid-laden macrophages&#46; Despite the administration of corticosteroids for a period of 6 months &#40;after discontinuing the use of Vaseline&#41;&#44; the results were very disappointing&#58; the man showed absolute stability of the HRCT findings and the woman&#39;s GGO component continued to worsen&#44; to a greater extent in the lower lobes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The clinical conditions of both patients worsened with further marked reduction in DLCO in both cases&#46; We are aware that this deterioration could be associated with an increased of level of inflammation due to fatty acids&#44; as described in a recent paper&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Fatty acids either remain in the alveolar compartment or are phagocytized by macrophages that then migrate to the interlobular septa&#46; This phenomenon could partly explain the meaning of the &#8220;crazy paving&#8221; pattern observed on HRCT&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> However&#44; we assume that reactivity of the affected lung is also consistent with organizing pneumonia&#44; leading to toxic lung injury&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Due to their critical clinical status&#44; our patients could not undergo a lung biopsy so our findings unfortunately remain only a hypothesis&#46; To sum up&#44; HRCT is the best imaging modality for establishing the diagnosis of lipoid pneumonia&#46; However&#44; there is an important issue which needs clarification&#58; according to Marchiori et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> consolidation is common in children&#44; while GGO and crazy paving are more often seen in adults&#46; The question here is why&#44; after treatment&#44; do areas of GGO and crazy paving sometimes become more extended but with no signs of fibrosis&#46; In conclusion&#44; in patients with pathological findings due to aspiration of petroleum jelly used to clean the tracheostoma&#44; a careful clinical evaluation with FEV1 spirometry and possibly low dose HRCT with narrowed slices is recommended in cases in which GGO is a dominant HRCT pattern&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Rea G&#44; Lassandro F&#44; Valente T&#46; Neumon&#237;a lipoidea ex&#243;gena en pacientes laringectomizados&#58; &#191;es el patr&#243;n de opacificaci&#243;n en vidrio esmerilado&#47;en empedrado una reacci&#243;n organizada de la neumon&#237;a capaz de predecir una mala evoluci&#243;n&#63;&#46; Arch Bronconeumol&#46; 2016&#59;52&#58;438&#8211;439&#46;</p>"
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                            3 => "A&#46; Ayala Carbonero"
                            4 => "M&#46;I&#46; Garc&#237;a G&#243;mez-Muriel"
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Letter to the Editor
Exogenous Lipoid Pneumonia in Laryngectomy Patients: Is Ground Glass Opacity/Crazy Paving Pattern an Organizing Pneumonia Reaction That Can Predict Poor Outcome?
Neumonía lipoidea exógena en pacientes laringectomizados: ¿es el patrón de opacificación en vidrio esmerilado/en empedrado una reacción organizada de la neumonía capaz de predecir una mala evolución?
Gaetano Rea
Corresponding author
gaetano.rea71@gmail.com

Corresponding author.
, Francesco Lassandro, Tullio Valente
Servicio de Radiología, Hospital Monaldi, Nápoles, Italy
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        "titulo" => "Neumon&#237;a lipoidea ex&#243;gena en pacientes laringectomizados&#58; &#191;es el patr&#243;n de opacificaci&#243;n en vidrio esmerilado&#47;en empedrado una reacci&#243;n organizada de la neumon&#237;a capaz de predecir una mala evoluci&#243;n&#63;"
      ]
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">High resolution computed tomography scan of the chest shows peribronchial fat consolidation in middle lobe &#40;white arrows&#41;&#46; Extensive representation of GGO containing subtle reticulation &#40;crazy paving&#41; up to pleural spaces &#40;black arrows&#41; 8 months after discontinuing petroleum jelly &#40;Vaseline&#41; and steroid therapy &#40;prolonged for 6 months&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with great interest the exogenous lipoid pneumonia &#40;ELP&#41; case series from Latorre et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> which elegantly demonstrates the radiological findings inherent to pathological aspiration of petroleum jelly &#40;Vaseline&#41;&#46; The authors report that the most common high-resolution computed tomography &#40;HRCT&#41; findings in ELP are areas of low attenuation and ground glass opacity &#40;GGO&#41;&#46; However&#44; on careful analysis&#44; the CT images for Case 1 exclusively show peribronchial consolidation tissue&#44; but no areas of GGO&#46; The second case reported&#44; supported by CT&#44; CT-PET and MRI&#44; very clearly shows fat in middle lobe&#46; Some of the clinical cases did not have an accompanying radiological image&#46; We respectfully would like to share our experience of two cases of aspiration of oily product&#44; used for cleaning the stoma in adult patients &#40;a 63-year-old woman and a 68-year-old man&#41; after laryngectomy for cancer&#46; Our patients showed an extended GGO component in the middle lobe&#44; lingula and lower lobes&#44; confirmed on bronchoalveolar lavage testing to be alveolar lipid-laden macrophages&#46; Despite the administration of corticosteroids for a period of 6 months &#40;after discontinuing the use of Vaseline&#41;&#44; the results were very disappointing&#58; the man showed absolute stability of the HRCT findings and the woman&#39;s GGO component continued to worsen&#44; to a greater extent in the lower lobes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The clinical conditions of both patients worsened with further marked reduction in DLCO in both cases&#46; We are aware that this deterioration could be associated with an increased of level of inflammation due to fatty acids&#44; as described in a recent paper&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Fatty acids either remain in the alveolar compartment or are phagocytized by macrophages that then migrate to the interlobular septa&#46; This phenomenon could partly explain the meaning of the &#8220;crazy paving&#8221; pattern observed on HRCT&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> However&#44; we assume that reactivity of the affected lung is also consistent with organizing pneumonia&#44; leading to toxic lung injury&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Due to their critical clinical status&#44; our patients could not undergo a lung biopsy so our findings unfortunately remain only a hypothesis&#46; To sum up&#44; HRCT is the best imaging modality for establishing the diagnosis of lipoid pneumonia&#46; However&#44; there is an important issue which needs clarification&#58; according to Marchiori et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> consolidation is common in children&#44; while GGO and crazy paving are more often seen in adults&#46; The question here is why&#44; after treatment&#44; do areas of GGO and crazy paving sometimes become more extended but with no signs of fibrosis&#46; In conclusion&#44; in patients with pathological findings due to aspiration of petroleum jelly used to clean the tracheostoma&#44; a careful clinical evaluation with FEV1 spirometry and possibly low dose HRCT with narrowed slices is recommended in cases in which GGO is a dominant HRCT pattern&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Rea G&#44; Lassandro F&#44; Valente T&#46; Neumon&#237;a lipoidea ex&#243;gena en pacientes laringectomizados&#58; &#191;es el patr&#243;n de opacificaci&#243;n en vidrio esmerilado&#47;en empedrado una reacci&#243;n organizada de la neumon&#237;a capaz de predecir una mala evoluci&#243;n&#63;&#46; Arch Bronconeumol&#46; 2016&#59;52&#58;438&#8211;439&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">High resolution computed tomography scan of the chest shows peribronchial fat consolidation in middle lobe &#40;white arrows&#41;&#46; Extensive representation of GGO containing subtle reticulation &#40;crazy paving&#41; up to pleural spaces &#40;black arrows&#41; 8 months after discontinuing petroleum jelly &#40;Vaseline&#41; and steroid therapy &#40;prolonged for 6 months&#41;&#46;</p>"
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ISSN: 15792129
Original language: English
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