PET POSITIVE BENIGN PULMONARY NODULES: AN UNUSUAL PRESENTATION OF LIPOID PNEUMONIA

TOPIC: Diffuse Lung Disease TYPE: Fellow Case Reports INTRODUCTION: Lipoid Pneumonia (LP) is a parenchymal disease usually related to aspiration or inhalation of fat containing substances that leads an acute reaction driven by lung macrophages. The etiology can on occasion be endogenous, but overall very rare has various radiologic presentations which may even mimic carcinoma, making its diagnosis elusive CASE PRESENTATION: A 57 year old woman was referred us due the incidental finding Chest CT left 1.5 cm hilar adenopathy and 6 mm right middle lobe 4 upper nodules. Additionally, 2.2 breast density seen. She former smoker (22 PY) who quit 20 years ago, with history cancer (s/p lumpectomy XRT 5 earlier, benign axillary dissection) hyperlipidemia. asymptomatic. Denied exposure coal, silica, asbestos worked as Certified Nurse Assistant.A PET-CT Scan ordered this interestingly revealed lower (LLL) medial pleural based 12 nodule several peripheral ill defined LLL subpleural densities, all these FDG uptake 4.8 5.4 respectively. Additionally there mediastinal (SUV 5.2) in area station 7 (though no clear seen images) 11L scan images showing 1 node. No elsewhere. Subsequently, endobronchial ultrasound (EBUS) guided aspirate biopsies were obtained, demonstrating malignancy being consistent lymph node sampling. Therefore biopsy performed revealing fragments alveolated parenchyma along presence giant cell cholesterol clefts. pneumonia diagnosed. follow-up 3 months later showed resolution densities unchanged adenopathy. DISCUSSION: LP radiologically malignancy. It been reported ages subcategorized into endogenous exogenous. Exogenous lipoid described (fire eaters) however more often associated chronic animal fat, mineral oil, vegetable oil inhalation. postulated fatty avoid trigger cough reflex impair muco-ciliary transport system becoming difficult expectorate. In alveoli they are engulfed macrophages unable metabolize it when released back alveoli, triggers reaction. Radiological manifestations not specific include reticular nodular patterns, ground glass opacification, intralobular septal thickening, spiculated mass fibrosis. These lesions have increased PET scan. CONCLUSIONS: requires tissue sampling REFERENCE #1: Betancourt SL, Martinez-Jimenez S, Rossi SE, Truong MT, Carrillo J, Erasmus JJ. pneumonia: spectrum clinical manifestations. AJR Am J Roentgenol. 2010 Jan;194(1):103-9. doi: 10.2214/AJR.09.3040. PMID: 20028911. #2: Khilnani GC, Hadda V. uncommon entity. Indian Med Sci. 2009 Oct;63(10):474-80. 10.4103/0019-5359.57639. 19901490. #3: Simmons A, Rouf E, Whittle J. Not your typical case exogenous pneumonia. Gen Intern Med. 2007;22(11):1613-1616. doi:10.1007/s11606-007-0280-7 DISCLOSURES: relevant relationships Syed Aleem, source=Web Response Fernando Fuentes, Edmundo Rubio,