Ercan AYAZ, Berna OĞUZ, Mithat HALİLOĞLU, Dilber ADEMHAN TURAL, Ebru YALÇIN, Uğur ÖZÇELİK, Kübra YÜKSEL

Complicated pneumonia due to exogenous toxic substances in children

Background. Toxic substances may be inhaled or aspirated not always by patients themselves but sometimes by healthcare providers unintentionally by nasogastric administrations or medications. Aspirated toxic particles may cause injury in the pulmonary epithelium at various levels of the respiratory tract, leading to a spectrum varying from simple symptoms to severe chronic disease. Imaging features of substances are different depending on their structure and are not well known. Moreover, on follow-up, radiologic findings are not well correlated with clinical findings which progress or recover more rapidly. Case. In this case series, we report three different chemical pneumonitis due to aspiration of exogenous substances of paint thinner, activated charcoal and liquid paraffin. We present three cases with chest radiographs, distinctive computed tomography findings and follow-up images. Conclusions. Aspiration of exogenous materials reveals typical imaging findings such as the metallic density of charcoals, fat attenuation of liquid paraffin and necrotic areas within consolidation in hydrocarbon poisoning. Recognition of imaging findings is very important for the diagnosis and characterization of toxic substances.

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1. Bahceci Erdem S, Nacaroglu HT, Isgüder R, Unsal Karkiner CS, Alper H, Can D. Pulmonary complications of chemical pneumonia; a case report. Arch Argent Pediatr 2016; 114: e245-e248.

2. Sen V, Kelekci S, Selimoglu Sen H, et al. An evaluation of cases of pneumonia that occurred secondary to hydrocarbon exposure in children. Eur Rev Med Pharmacol Sci 2013; 17(Suppl 1): 9-12.

3. Salgado IA, Santos CC, Salgado JV, Ferraz PC, Haidar DM, Pereira HA. Exogenous lipoid pneumonia in children: a disease to be reminded of. Rev Assoc Med Bras 2012; 58: 135-137.

4. Lifshitz M, Sofer S, Gorodischer R. Hydrocarbon poisoning in children: a 5-year retrospective study. Wilderness Environ Med 2003; 14: 78-82.

5. Taş S, Durum Y, Karaman C. Fire-eater’s pneumonia. Diagn Interv Radiol 2015; 21: 267-268.

6. Makrygianni EA, Palamidou F, Kaditis AG. Respiratory complications following hydrocarbon aspiration in children. Pediatr Pulmonol 2016; 51: 560-569.

7. Graff GR, Stark J, Berkenbosch JW, Holcomb GW 3rd, Garola RE. Chronic lung disease after activated charcoal aspiration. Pediatrics 2002; 109: 959-961.

8. Bairral BQ, Saito M, Morrone N. Activated charcoal bronchial aspiration. J Bras Pneumol 2012; 38: 533- 534.

9. Nobre LF, Marchiori E, Forte DY, Zanetti G. Pleuropulmonary complications related to pulmonary instillation of activated charcoal. J Bras Pneumol 2013; 39: 396-397.

10. Betancourt SL, Martinez-Jimenez S, Rossi SE, Truong MT, Carrillo J, Erasmus JJ. Lipoid pneumonia: spectrum of clinical and radiologic manifestations. AJR Am J Roentgenol 2010; 194: 103-109