Lipoid pneumonia

Changed by Yuranga Weerakkody, 16 Nov 2016

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Lipoid pneumonia can either result from aspiration of oily substances (exogenous lipoid pneumonia) or endogenous accumulation of lipid substances in the alveoli (endogenous lipoid pneumonia).

Clinical presentation

Most patients are asymptomatic and often discovered incidentally.

Pathology

Lipid-laden macrophages are often seen histological samples following transthoracic needle biopsy. With exogenous forms Inhaled lipid content is phagocytosed by macrophages which fill alveoli. A subsequent acute + / - chronic pneumonitis results.

Macroscopically the affected regions often have 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

neuromuscular disorders
oesophageal abnormalities
cleft palate

Associations

The endogenous type can be seen in association with lung cancer ².

Complications

A fibrotic component can develop in chronic cases.

Radiographic features

RadiographPlain radiograph

can be variable ³
radiological spectrum with consolidation to irregular mass like lesion to a reticulonodular pattern

CT

characteristically show low attenuation within the consolidated areas of ~ -100HU reflecting a fat content
consolidation may have a predilection for the dependent portions of the lungs ³
associated ossific foci may be present within the affected region
a crazy paving pattern may also be seen

MRI

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

T1: ~~- high~~ high to intermediate signal ⁷
T2: ~~- low~~ low to intermediate signal ⁷

Treatment and prognosis

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

-</ul><h5>Associations</h5><p>The endogenous type can be seen in association with <a href="/articles/lung-cancer-3">lung cancer</a> <sup>2</sup>.</p><h5>Complications</h5><p>A fibrotic component can develop in chronic cases.</p><h4>Radiographic features</h4><h5>Radiograph</h5><ul>
+</ul><h5>Associations</h5><p>The endogenous type can be seen in association with <a href="/articles/lung-cancer-3">lung cancer</a> <sup>2</sup>.</p><h5>Complications</h5><p>A fibrotic component can develop in chronic cases.</p><h4>Radiographic features</h4><h5>Plain radiograph</h5><ul>
~~-<strong>T1</strong> - high to intermediate signal <sup>7</sup>~~
+<strong>T1:</strong> high to intermediate signal <sup>7</sup>
~~-<strong>T2</strong> - low to intermediate signal <sup>7</sup>~~
+<strong>T2:</strong> low to intermediate signal <sup>7</sup>

References changed:

9. Franquet T, Giménez A, Rosón N, Torrubia S, Sabaté JM, Pérez C. Aspiration diseases: findings, pitfalls, and differential diagnosis. Radiographics : a review publication of the Radiological Society of North America, Inc. 20 (3): 673-85. <a href="https://doi.org/10.1148/radiographics.20.3.g00ma01673">doi:10.1148/radiographics.20.3.g00ma01673</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10835120">Pubmed</a> <div class="ref_v2"></div>

Images Changes:

Image 3 CT (lung window) ( create )

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