Foreign body granulomata of the lungs due to liquid paraffin.

HISTORICAL The recognition of oil granulomata of the lung followed the use of oils as a vehicle for medicaments and radio-opaque substances in diagnostic bronchography. Rosenberg (1885) used menthol in olive oil for the treatment of tuberculous laryngitis. This treatment was fairly widely adopted. Following the discovery of the efficacy of chaulmoogra oil as a treatment for leprosy this oil was substituted for the menthol by Lukens (1922). They believed that medicated oils did not penetrate further than the larynx. This was disproved by GuieyssePellissier (1920), who showed, in rabbits, that olive oil injected into the larynx could be demonstrated in the alveoli within six hours. Corper and Freed (1922) showed that oil placed in the nasal cavity was also carried to the alveoli. Laughlen (1925) first described cases of lipoid pneumonia following the use of nose drops of which the base was liquid paraffin. Pinkerton (1927) described six cases in which he could trace the pathogenesis from a simple lipoid pneumonia to a discrete fibrotic oil granuloma. Graef (1935) suggested that mineral oils gain entrance to the lungs by (a) not irritating the surface of the pharyngeal mucosa and so not exciting a cough reflex; (b) the presence of mild anaesthetic substances in the mineral oil, such as menthol, enhancing the passage of the oil into the trachea; (c) a defect of the cilia in chronic respiratory infections; and (d) loss of the cough reflex in weakand debilitated patients. Ikeda (1937) distinguished between infantile and adult forms of lipoid pneumonia. The " infantile form" can occur in infants and the aged. This lesion, usually of a diffuse nature, is essentially an interstitial proliferative inflammation not infrequently combined with exudative pneumonia. The " adult type," usually localized, mostly occurs among older persons as a result of the habitual self-administration of oil in large amounts by mouth or intra-nasally over a long period, and occasionally also as a result of direct intra-tracheal instillation. Ikeda pointed out the clinical and radiographical difficulty of distinguishing these "adult " lesions from other intrapulmonary lesions.