Unusual Case of Carcinoma of Both Lungs Associated With Lipoid Pneumonia

Abstract

A 52-year-old, single French-Canadian housemaid was admitted to the Presbyterian Hospital, New York (No. 640620) in April 1941. Her symptoms began ten months before admission with an acute upper respiratory infection which subsided in one week. Following this she had a lingering cough which persisted until admission. The cough was productive of only a small amount of whitish milky sputum at this time. Six months before admission the cough became productive of about two cupfuls daily of thin, watery, odorless sputum without blood. Three months before admission the patient began to experience dyspnea on exertion. Throughout the ten months of her present illness she lost 25 pounds and experienced several, irregularly spaced, short febrile attacks. Ten years before admission the patient had had sinusitis, which was later recurrent and chronic. At the time of her first episode of sinusitis she used four bottles of oily nose drops in one week. She continued to use this material intermittently but never again in such large quantities. She habitually used mineral oil for constipation for at least fifteen years before her present illness. On admission her temperature was 100° F. and it was not strikingly elevated at any time. Her respirations were of increased frequency, and physical examination showed her to be extremely dyspneic and cyanotic even at rest, but she was able to lie flat in bed. Physical signs suggestive of incomplete consolidation were found over the lower two-thirds of both lungs. There was no evidence of clubbed fingers, increased venous pressure, or peripheral edema. The patient continued to produce from one to two pints daily of thin, odorless, whitish, milky, foamy sputum without blood. Many fat droplets and numerous fatty acid crystals were identified in the sputum. No tubercle bacilli or fungi were found on repeated examinations. During her hospital stay the patient became steadily worse. There was complete failure of response to sulfadiazine. Near the end she was markedly cyanotic and dyspneic in spite of breathing pure oxygen continuously. She died on the seventeenth hospital day. Films of the chest on admission showed a fairly dense, homogeneous shadow in the lower two-thirds of both lung fields, more extensive at the bases and along the lateral chest wall. The shadows became less dense and more mottled toward the apices. Air-containing lung could be seen only in the apices and peri-hilar regions. The lesions appeared quite symmetrical in the two lungs. Planigraphic sections showed well the air-filled tree of the trachea, stem bronchi, and larger branches. The contour was regular and there was no evidence of a lesion in the bronchial tree or of pressure or constriction from the outside. Another roentgen examination shortly before death showed no change in the lung shadows.