Philippe Camus, M.D.

Dijon, France

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Paraffin-Vaseline-Oil-Lipids (Mineral or other) p.o./inhaled/aspirated

When taken orally longterm, particularly in patients with chronic aspiration from oropharyngeal dysphagia, swallowing disorders, achalasia or with prior radiation therapy to the neck, machine or mineral oil, paraffin, shark liver oil or vaseline may cause diffuse or localized opacities or a mass-like lesion of lipoid pneumonia (the latter is named paraffinoma). Involved areas can be low attenuation on HRCT, high signal intensity on T1 and T2 spin-echo on MRI and tracer-avid on PET scan. Series and reviews at PMID 8836660 and 20118714. Specifics of mineral oil/lipid staining and tinctorial histochemistry at PMID 8129503. Whole lung lavage may be considered in severe cases or in those refractory to oil withdrawal (PMID 27287091)

Frequency - Incidence

Incidence of respiratory adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for respiratory adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Interstitial/parenchymal lung disease

I.a

Pneumonitis (interstitial lung disease/ILD)
I.g

Pulmonary fibrosis
I.k

Exogenous lipoid pneumonia (subacute, acute)
I.l

Lung nodule or nodules
I.t

A mass or masses
I.aa

An area or areas of consolidation
I.aq

Paraffinoma - Lipidoma (ELP in the form of a nodule or mass)

XLI - Pulmonary edema - Acute lung injury - ARDS

XLI.e

ARDS - Acute lung injury

XLII - Pulmonary/alveolar./airway hemorrhage/bleeding

XLII.c

Hemoptysis

XLIII - Airway involvement

XLIII.r

Plugs/casts in the airways

XLVII - Mediastinal involvement

XLVII.p

Lipid-laden mediastinal lymphadenopathy

XLIX - Systemic/Distant conditions, syndromes and reactions

XLIX.e

Autoimmunity-Autoimmune conditions (+ANA, +anti-ds-DNA, +ANCAs, other auto-Abs)

LV - Imaging

LV.a

Imaging: Diffuse haze
LV.b

Imaging: Ground-glass opacities (GGO) / shadowing
LV.f

Imaging: Bibasilar opacities/shadowing
LV.i

Imaging: An area or areas of involvement with a recognizable anatomic distribution
LV.k

Imaging: An area or areas of consolidation
LV.n

Imaging: Intralobular septal thickening - Crazy paving
LV.r

Imaging: An area or areas of involvement with low attenuation numbers
LV.w

Imaging: Lung nodule or nodules
LV.aa

Imaging: A large nodule or a mass
LV.ac

Imaging: Cavitating/cavitary lung nodule, mass or nodules (see also Iq, XIs, XIIi, XVIaa and XVIIp)
LV.bb

Imaging: Solitary pulmonary nodule
LV.be

Imaging: Intrathoracic lymph node enlargement

LVI - Distinctive patterns - 'Eye-catchers'

LVI.r

Eye catcher: A milky, cloudy or lumpy BAL fluid

LVII - Cytological, biochemical features of/in BAL, pleural fluid or FNA

LVII.a

BAL: An excess proportion of lymphocytes
LVII.h

BAL: Exogenous (oil red O-stainable) lipids in BAL macrophages

LVII.j

BAL: Free exogenous lipids in supernatant

LVIII - Pathology

LVIII.f

Path: ILD with a granulomatous component (see also Im)
LVIII.v

Path: NSIP-fibrotic pattern
LVIII.z

Path: Exogenous lipoid pneumonia
LVIII.ab

Path: Foreign body deposits/granulomatous reaction
LVIII.de

Path: Exogenous lipid-laden lymphadenopathy

LIX - Infections & related conditions

LIX.h

Nontuberculous pulmonary mycobacterial infection/superinfection

LX - Neoplastic conditions

LX.a

Lung cancer

LXV - Veterinary medicine

LXV.c

Veterinary: Exogenous lipoid pneumonia