Pediatric Pulmonology 44:309–315 (2009) Original Articles Clinic and Radiological Improvement of Lipoid Pneumonia With Multiple Bronchoalveolar Lavages Selma M.A. Sias, MD, MSc, 1 * Pedro A. Daltro, MD, 2 Edson Marchiori, MD, PhD, 3 Angela S. Ferreira, MD, PhD, 4 Regina L. Caetano, MSc, 5 Cleonice S. Silva, MD, PhD, 6 Nestor L. Mu ¨ ller, MD, PhD, 6 Jose Moreira, MD, PhD, 7 and Thereza Quirico-Santos, PhD 5 Summary. Objective: To assess the potential role of multiple bronchoalveolar lavages (BALs) in the treatment of children with lipoid pneumonia (LP). Materials and Methods: This prospective study included 10 children (7 female, 3 male) with LP secondary to mineral oil aspiration. The age ranged from 3 months to 7 years and 1–60 days history of mineral oil intake, with a 6 months clinic follow-up. High-resolution computer tomography (CT) was performed 1–7 days prior to treatment and 2–20 days after the last therapeutic BAL, and reviewed by two experienced chest radiologists. Oxygen saturation was measured with digital oximetry. Therapeutic BAL was performed weekly until BAL fluid was nearly transparent and the cell count returned to normal range values. Results: In all children, the initial CT scans showed multifocal bilateral consolidation involving mainly the dorsal and central regions. The areas of consolidation had foci of decreased attenuation in eight patients. Following a total of 4–10 therapeutic BALs, the CTscans returned to normal in 3 patients, improved considerably in 5, and showed only slight improvement in 2. Oxygen saturation increased from 88.8  3.4% at presentation to 96.2  0.8% after treatment (P < 0.0001). Multiple lavages reduced (P < 0.003) numbers of lipid-laden macrophages and restored BAL cellularity to normal range values. Conclusion: Multiple therapeutic BAL of children with LP results in significant improvement of CT findings, oxygen saturation, restoration of BAL fluid cellularity and clinical recover without any evidence of respiratory distress at the end of treatment and 6 months after the last BAL. Pediatr Pulmonol. 2009; 44:309–315. ß 2009 Wiley-Liss, Inc. Key words: lipoid pneumonia; bronchoalveolar lavage; computed tomography; therapy; mineral oil. INTRODUCTION The majority of cases of lipoid pneumonia (LP) in children are secondary to aspiration of mineral oil. 1 In many countries mineral oil is used in the treatment of constipation and of partial small bowel obstruction by Ascaris lumbricoides. 2–4 The high viscosity of mineral oil facilitates aspiration even in normal individuals. In 1 Department of Pediatrics, Hospital Universitario Antonio Pedro, Fluminense Federal University, Rio de Janeiro, Brazil. 2 Department of Radiology, Fernandes Figueira Institute—FIOCRUZ, Rio de Janeiro, Brazil. 3 Department of Radiology, Fluminense Federal University, Rio de Janeiro, Brazil. 4 Department of Pneumology, Fluminense Federal University, Rio de Janeiro, Brazil. 5 Department of Cellular and Molecular Biology, Fluminense Federal University, Rio de Janeiro, Brazil. 6 Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, Canada. 7 Department of Pneumology, Rio Grande do Sul Federal University, Porto Alegre, Brazil. *Correspondence to: Selma M.A. Sias, MD, MSc, Department of Pediatrics, Hospital Universitario Antonio Pedro, Rua Marques do Parana 303, Centro Niteroi, Rio de Janeiro 24030-120, Brazil. E-mail: selma_sias@vm.uff.br Received 11 April 2008; Revised 1 July 2008; Accepted 1 July 2008. DOI 10.1002/ppul.20918 Published online 12 March 2009 in Wiley InterScience (www.interscience.wiley.com). Grant sponsor: Coordenac ¸a ˜o de Aperfeic ¸oamento de Pessoal de Nı ´vel Superior (CAPES); Grant sponsor: Fundac ¸a ˜o Euclides da Cunha—UFF (FEC-UFF). ß 2009 Wiley-Liss, Inc.