Lipoid Pneumonia

Lipoid pneumonia is a condition where the small air sacs in your lungs (alveoli) are inflamed and filled with fats or oils (lipids). This can happen if you accidentally breathe in or aspirate oily substances. Examples of oily substances include cooking oil, essential oils, vaping oils, petroleum jelly, nasal sprays or decongestants that contain mineral oils. It can also happen if a medical condition causes your body to make or store too much fat in your lungs.

Types

Lipoid pneumonia can be endogenous or exogenous:

• Endogenous lipoid pneumonia is when lipids released by your body build up inside your lungs. It’s also called cholesterol pneumonia or golden pneumonia.
• Exogenous lipoid pneumonia is when oily or fatty substances get into your lungs from outside your body. This can be acute (sudden onset) or chronic (lasting a long time).

Acute lipoid pneumonia can happen when you breathe in or aspirate an oily substance, like cooking oils or certain cosmetics. Aspiration is when you get something in your lungs instead of your stomach, or have it “go down the wrong pipe.”

Chronic lipoid pneumonia is more likely to happen if you’re exposed to oily substances often, like working around oils that form a spray or mist. Breathing in that oily mist over and over can cause a slow buildup of fat in your lungs over time. It can also happen from repeated use of oil-based nasal sprays, decongestants or vaporized oils like cannabis oil or essential oils.

What are the symptoms of lipoid pneumonia?

Symptoms of lipoid pneumonia include:

• Cough
• Shortness of breath (dyspnea)
• Fever
• Coughing up blood
• Chest pain

These symptoms can start within a few hours of breathing in or aspirating oils, or develop slowly over time.

What causes lipoid pneumonia?

Lipoid pneumonia happens when you have inflammation and a buildup of fatty or oily substances (lipids) in the small air sacs in your lungs. This can happen when:

• Lipids move from another part of your body into your lungs
• Damage to your lungs causes them to release lipids and become inflamed
• You breathe in or aspirate oil-based substances

Oil-based substances include cooking or manufacturing oils, essential oils, cosmetics, mentholatum (used in some medical ointments), petroleum jelly, oil-based vaping materials (like cannabis oil), volatile oil or nasal decongestants (which often contain mineral oils or paraffin).

Rarely, a genetic disease that makes it hard for your body to break down fats can cause it. These diseases are usually found in babies or young kids, but sometimes show up later in life. If you have lipoid pneumonia and doctors can’t find a clear cause, they may look for one of these conditions.

What are the risk factors?

You might be at higher risk for lipoid pneumonia if you:

• Vape
• Have a job or hobby that exposes you to droplets or mists that contain oil (like some manufacturing jobs or fire eating)
• Have chronic acid reflux (GERD)
• Have a neuromuscular disorder or another health condition that makes it easier to aspirate
• Have a lipid storage disease, like Gaucher disease or Niemann-Pick disease

Complications

Complications of lipoid pneumonia include:

• Secondary bacterial infections
• Lung scarring (pulmonary fibrosis)
• Right-sided heart failure (cor pulmonale)
• Respiratory failure

How is lipoid pneumonia diagnosed?

Healthcare providers diagnose lipoid pneumonia based on:

• Your symptoms
• Your health history and whether you could’ve breathed in or aspirated oils
• Imaging (like chest X-rays or CT scans)
• Bronchoscopy (examining the inside of your lungs with a thin tube and a camera)
• Examining fluids or tissues under a microscope (cytology or biopsy) to check for signs of oil and inflammation in your lungs

There aren’t any specific blood tests that help providers diagnose lipoid pneumonia. Sometimes, people who don’t have any symptoms are diagnosed when they get a chest X-ray for unrelated reasons.

How is it treated?

There’s no one treatment for lipoid pneumonia. If you might be aspirating oils or other substances that cause it, avoiding them is the first step to getting better. Other treatments could include:

• Antibiotics to treat bacterial infections
• Corticosteroids to reduce inflammation
• Supplemental oxygen to help you breathe better

You may also need specific treatments for health conditions that can cause lipids to build up or make you more likely to aspirate. If you have a genetic condition leading to lipoid pneumonia, your provider may recommend enzyme replacement therapy to help break down fats. You might also receive supportive treatments like corticosteroids and oxygen.

When should I see my healthcare provider?

Talk to your healthcare provider if you have a long-lasting cough, shortness of breath or any other concerning symptoms.

It might be helpful to ask them:

• What caused this?
• Could it happen again?
• What are my treatment options?
• Do I need additional tests to look for conditions that lead to aspiration?
• When should I follow up with you?

When should I go to the ER?

Call 911 (or your local emergency service number) or go to the emergency room if you have symptoms like chest pain, high fever and difficulty breathing. Pneumonia can get worse quickly.

Can you recover from lipoid pneumonia?

Yes, most people with lipoid pneumonia from aspiration recover completely. People with health conditions that cause a buildup of lipids are more likely to have life-threatening complications. Chronic lipoid pneumonia can lead to permanent lung scarring that may get worse over time.

Can lipoid pneumonia be prevented?

You can reduce your risk of lipoid pneumonia by:

• Managing health conditions that make you more likely to aspirate
• Avoiding activities that increase your risk of getting oil in your lungs
• Managing any conditions that cause a buildup of lipids
• Sitting up when you eat or drink to avoid aspiration

Only feed a baby or small child medications with oil if their healthcare provider recommends it. Ask for the best way to feed it to them to avoid aspiration.