Lipoid pneumonia is a form of pneumonia associated with oily or lipid components within the pneumonitis component.

This can either result from

Clinical presentation

Most patients are asymptomatic and often discovered incidentally.


Lipid-laden macrophages are often seen in histological samples following transthoracic needle biopsy. With exogenous forms, inhaled lipid content (e.g. from aspiration) is phagocytosed by macrophages which fill alveoli. A subsequent acute +/- chronic pneumonitis results.

Macroscopically the affected regions often have a yellowish or golden hue, which is thought to be produced by the liberation of lipid material from alveolar pneumocytes secondary to the inflammatory reaction.

Risk factors
  • aspiration risk
    • neuromuscular disorders
    • esophageal abnormalities
    • cleft palate

The endogenous type can be seen in association with lung cancer .

Case reports are emerging in patients who use e-cigarettes (vaping) .


A fibrotic component can develop in chronic cases.

Other possible complications include:

  • superinfection by non-tuberculous mycobacteria
  • respiratory insufficiency
  • cor-pulmonale
  • hypercalcemia

Radiographic features

Plain radiograph
  • can be variable
  • radiological spectrum with consolidation to an irregular mass-like lesion to a reticulonodular pattern
  • characteristically show low attenuation within the consolidated areas (low attenuation consolidation) of ~ -100 HU reflecting a fat content (at times the attenuation value may be less i.e. around -30 HU and higher than that of subcutaneous fat )
  • consolidation may have a predilection for the dependent portions of the lungs
  • associated ossific foci may be present within the affected region
  • a crazy paving pattern may also be seen

Not part of routine evaluation. Signal characteristics may reflect fat/paraffin content. usually:

  • T1: high to intermediate signal
  • T2: low to intermediate signal

Treatment and prognosis

Serial radiographs showing stability may be enough in asymptomatic patients with no background history. A biopsy can be performed in some of the cases to ensure the benign nature of the lesion, especially if changes are lipid-poor and imaging features persistent.

The mainstay of management in exogenous types is control and cessation of offending agent(s).

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