Lipid pneumonia

Lipid pneumonia also known as lipoid pneumonia or cholesterol pneumonia; is a specific form of lung inflammation that develops when lipids enter the bronchial tree.

See Pneumonia for details.

Represents a foreign body reaction causing cough, dyspnea, and often fever.

It is a disorder characterized by the accumulation of either endogenous or exogenous lipid in the alveoli.

There are two types of lipoid pneumonia:

Exogenous lipoid pneumonia: This occurs when the fat particles enter from outside the body and reach the lungs via the nose or mouth.

Endogenous lipoid pneumonia: In this type, fat particles accumulate in the lungs, causing inflammation.

Endogenous lipoid pneumonia is also known as cholesterol pneumonia, golden pneumonia, or in some cases idiopathic lipoid pneumonia.

Endogenous lipoid pneumonia: In this type, fat particles accumulate in the lungs, causing inflammation.

Endogenous lipoid pneumonia is also known as cholesterol pneumonia, golden pneumonia, or in some cases idiopathic lipoid pneumonia.

Endogenous lipoid pneumonia is a spectrum of disorders in which lung injury is caused by aspiration of gastric contents or exogenous substances.

The cause of endogenous lipoid pneumonia is not clear.

Risk factors for endogenous lipoid pneumonia include:

bronchiolitis obliterans


connective tissue disease

fungal pneumonia

lung cancer

necrotizing granulomatosis

Niemann-Pick disease

pulmonary alveolar proteinosis (PAP)

pulmonary tuberculosis

sclerosing cholangitis

Gaucher’s disease

rheumatoid arthritis

It often occurs when an airway is blocked, such as by a lung tumor.

Blockages can cause cells to break down and become inflamed, which results in a buildup of debris.

This debris might include cholesterol, that can trigger inflammation.

The condition can also be brought on by the long-term inhalation of dust and other irritating substances, certain infections, and genetic problems with breaking down fats.

Exposures linked to exogenous lipoid pneumonia include: petroleum jelly, mineral oil, vegetable oil, excessive use of lip balm, and occupational exposure to paraffin or other oily materials such as spray paints and machinery lubricants.

The ingestion of mineral oil allows it to accumulate on top of gastric fluids, a biophysical feature that may increase the risk of aspiration of the mineral oil in patients with gastroesophageal reflux disease.

Endogenous lipoid pneumonia reflects endogenous lipid accumulation, predominantly within the air space and is not a specific disorder but a component of disorders in which surfactant clearance is impaired, as with airway obstruction, macrophage dysfunction, or disordered surfactant metabolism.

Many oil containing substances, including mineral oil laxatives,  can be aspirated or inhaled and illicit a chronic foreign body reaction whereby alveolar macrophages phagocytoses the lipids but cannot metabolize them.

The macrophages subsequently release lipids perpetuating the cycle, and inciting a granulomatous reaction, chronic inflammation, and eventually fibrosis.

Hemoptysis may occur.

Exogenous: sources include inhaled nose drops with an oil base, or accidental inhalation of cosmetic oil, or amiodarone the anti-arrythmic drug known to cause this condition.

Exogenous lipoid pneumonia results from aspiration or inhalation of animal, mineral, or vegetable oils.

Mineral oil–based laxatives are among the most common inhaled or aspirated substances to cause exogenous lipoid pneumonia.

Other fatty substances that can cause exogenous lipoid pneumonia include:

oils present in foods, including olive oil, milk, poppyseed oil, and egg yolks

oil-based medication and nasal drops

oil-based laxatives, including cod liver oil and paraffin oil

petroleum jelly

kerdan, a type of petroleum used by performers who “eat” fire

oils used at home or in the workplace, including WD-40, paints, and lubricants

oil-based substances found in e-cigarettes

Once in the lungs, the substance causes an inflammatory reaction.

The severity of the reaction often depends on the type of oil and the length of exposure.

Severe inflammation can permanently damage the lungs.

Individuals at risk include the elderly, developmentally delayed or persons with gastroesophageal reflux.

Risk factors for exogenous lipoid pneumonia include:

neuromuscular disorders that affect the swallow reflex

forced oil intake

gastroesophageal reflux disease (GERD)

snorting oil-based drugs

loss of consciousness

oil pulling

psychiatric disorders

throat or esophagus abnormalities, including hernias and fistulas


oral ingestion and aspiration of mineral oil used as a laxative

At the microscopic scale foamy macrophages and giant cells are seen in the airways, and an inflammatory response is visible in the parenchyma.

Patients may be asymptomatic or present with non-specific symptoms, including fever, dyspnea, cough, and weight loss.

Symptoms of lipoid pneumonia tend to worsen over time. In some cases, they can become severe or even life-threatening.

Some common symptoms of lipoid pneumonia can include:

chest pain

chronic cough

difficulty breathing

Less common symptoms can include:


coughing up blood

weight loss

night sweats

difficulty swallowing

Pulmonary function tests may show obstructive or restrictive abnormalities.

Exogenous lipid pneumonia has been noted in all age groups with a predisposition to aspiration related to gastroesophageal reflux disease, anatomical anomalies, or neurologic disease.

Exogenous lipoid pneumonia increases the susceptibility to bacterial and nontuberculous mycobacteria.


bronchoscopies with bronchoalveolar lavage

CT scans

needle aspiration biopsies

pulmonary function tests

Possible tests include:

bronchoscopies with bronchoalveolar lavage

CT scans

needle aspiration biopsies

pulmonary function tests

Imaging studies of exogenous lipid pneumonia frequently manifest as ground glass or consolidative opacities in the lower lung lobes.

Crazy paving has been described in association with exogenous lipoid pneumonia.

Bronchoalveolar lavage from patients with exogenous lipoid pneumonia usually have a grossly milky or oily appearance.

Lipid laden macrophages with cytoplasmic vacuoles arr typically present with evidence of chronic inflammation, histiocytrs, and fibrosis.

Transbronchial biopsy can provide sufficient tissue for diagnosis of exogenous lipoid pneumonia.

Treatment of exogenous lipoid pneumonia is focused on terminating the abnormal exposure.


Treatment depends on the type and cause of lipoid pneumonia, as well as the severity of symptoms.

With exogenous lipoid pneumonia, eliminating exposure to the fatty substance is often enough to improve symptoms.

Treatment is with corticosteroids and possibly intravenous immunoglobulins.

Whole lung lavage in surgical resection for localized o disease are other treatment options.

Other treatments, including oxygen therapy and respiratory therapy, can make breathing easier for people with lipoid pneumonia.

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