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Virtual Pediatric Hospital: Paediapaedia: Pneumonia, Hydrocarbon Paediapaedia: Chest and Airway Diseases

Pneumonia, Hydrocarbon

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
Respiratory distress including grunting, cough, and fever after the aspiration of hydrocarbons. Symptoms may develop in minutes or hours depending on the volume aspirated.

Etiology/Pathophysiology:
The causative hydrocarbon agents are petroleum solvents, dry cleaning fluid, lighter fluid, kerosene, gasoline, and liquid polishes and waxes. Once aspirated, due to their low viscosity and surface tension, they reach the dependent portion of the lung and cause a chemical pneumonia. Pulmonary edema can develop rapidly. Long term there can be loss of elastic recoil, and small airway obstruction, which can lead to increased reactive airway disease and chronic lung disease in adults.

Pathology:
Necrosis of the airways, atelectasis, interstitial inflammation, hemorrhage, pulmonary edema, vascular thrombosis, bronchopneumonia, and hyaline membrane formation can all occur.

Imaging Findings:
CXR changes can be seen between 6-24 hours after aspiration which vary from punctate infiltrates to massive lung opacification and are more common in the dependent portion of the lungs. Air trapping and pleural effusions may also be seen. The CXR findings peak at 72 hours after aspiration and persist up to 3-4 weeks. Pneumatoceles can be seen during the healing phase due to airway necrosis complicated by air trapping. The CXR does not correlate with clinical findings.

DDX:

References:
See References Chapter.

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