Diesel Siphoner's Lung: Acute exogenous lipoid pneumonia following accidental aspiration of diesel fuel-two case reports and a literature review.

Background: Diesel Siphoner's Lung is a severe, life-threatening subtype of acute exogenous lipoid pneumonia (ELP) caused by accidental diesel fuel aspiration. While diagnosis is typically straightforward with a clear exposure history, clinical management is challenging due to rapidly progressive respiratory failure. Given the relative rarity of such accidents and the lack of standardized management guidelines, optimizing therapeutic strategies remains a significant clinical challenge. Case presentation: We report two cases of acute ELP resulting from diesel siphoning-a distinct clinical entity termed 'Diesel Siphoner's Lung'-demonstrating highly divergent clinical trajectories. Case 1, a previously healthy 48-year-old male, presented with acute lung injury (ALI) 8 hours post-aspiration. Prompt interventions, including endotracheal intubation, serial segmental bronchoalveolar lavage (sBAL) and systemic corticosteroid therapy, were adopted. Following progressive clinical improvement, the patient was extubated on the 8th day and subsequently discharged on the 25th day with substantial radiological resolution. Conversely, Case 2-a 45-year-old male with a history of diabetes and hypertension-was admitted with established acute respiratory distress syndrome (ARDS) 2 days post-aspiration. His clinical course was severely complicated by multidrug-resistant nosocomial infections and a left-sided hydropneumothorax, refractory to similar clinical management with endotracheal intubation, serial sBAL, and systemic corticosteroid therapy. Despite the initiation of extracorporeal membrane oxygenation (ECMO) rescue therapy on the 11th day, the patient ultimately succumbed to multiple organ failure on the 19th day. Conclusion: The divergent outcomes of our two reported cases, coupled with findings from the relevant literature, highlight the critical necessity of an multimodal intervention strategy. We advocate for the prompt implementation of sBAL to mechanically remove aspirated lipids and halt ongoing chemical cytotoxicity, combined with early systemic corticosteroid therapy to attenuate the fulminant inflammatory cascade. Furthermore, in severe cases presenting with refractory hypoxemia and irreversible pulmonary damage, ECMO should be recognized as a viable and crucial bridge to subsequent lung transplantation.