Lipid pneumonia J69.1

Laughlen is considered the first to have described lipid pneumonia, having first documented the clinical picture in 1925 (Schwaiblmair 2010).

Rieger (1999), however, identifies Adams as the first to describe lipid pneumonia in adults, having described the clinical picture in 1947.

Lipid pneumonia resulting from the use of e-cigarettes (vaping) was first described in 2019 at the University of Utah Health (Maddock 2019).

Lipid pneumonia is defined as a chronic interstitial pneumonia characterized by the deposition of endogenous or exogenous lipids in the lungs, followed by an inflammatory response (Hentschel 2025).

Lipid pneumonia is a rare form of pneumonia (Herold 2025), and its exogenous form, in particular, is often underdiagnosed (Guyard 2024).

Lipid pneumonia is caused by:

• Endogenous causes such as
  • tumorous bronchial obstruction
  • tumor lysis (Herold 2025)
  • Deposition of endogenous cholesterol, e.g., in lipid storage disorders or hyperlipidemia (Merza 2023)
• Exogenous causes, such as
  • Aspiration of oils or fats (Herold 2025)
  • Aspiration or inhalation of lipid-containing nasal sprays
  • Use of e-cigarettes / vaping (Merza 2023)

Lipid pneumonia—with the exception of pneumonia caused by vaping—primarily affects older adults (Maddock 2019).

Typically, the lower lobes are frequently affected by lipid pneumonia (Merza 2023).

In mild cases, there are generally no symptoms. Otherwise, cough, dyspnea, low-grade fever (Herold 2025), and hemoptysis may occur (Schwaiblmair 2010

The diagnosis is made using high-resolution thin-section computed tomography (Merza 2023), as this is superior to a chest X-ray, and through bronchoscopy (Herold 2025).

Computed tomography:

CT scans often reveal ground-glass opacities, consolidations, and a “crazy-paving” pattern—that is, ground-glass opacities with thickening of the interlobular septa (Merza 2023)—as well as round pulmonary lesions (Chieng 2022).

Bronchoscopy:

During this procedure, cell and tissue samples should be collected, which typically reveal lipid-laden macrophages (Herold 2025).

• Other Causes of Pneumonia ( Hentschel 2025)
• Malignant process
• Hamartomas
• Lipomas
• Liposarcomas (Merza 2023)

• Superinfections
• Development of bronchial carcinoma (Schwaiblmair 2010).

For exogenous forms, the primary treatment should be avoidance of exposure (Hentschel 2025).

Causal therapy is the most important form of treatment for the endogenous form; otherwise, only symptomatic measures are possible (Herold 2025).

Steroid therapy is considered highly controversial (Schwaiblmair 2010).

The prognosis may vary depending on the cause, duration of exposure, etc. (Merza 2023).

1. Chieng H C, Ibrahim A, Chong W H, Freed H, Fabian T, Saha B, Foulke L, Chopra A (2022) Am J Med Sci. 363 (5) 452–455
2. Guyard A, Cazes A (2024) Exogenous lipid pneumonia. Ann Pathol. 44 (6) 498–504
3. Hentschel H et al. (2025) Lipid Pneumonia. Doc Check Flexikon https://flexikon.doccheck.com/de/Lipidpneumonie
4. Herold G et al. (2025) Internal Medicine. Herold Verlag 389
5. Kasper D L, Fauci A S, Hauser S L, Longo D L, Jameson J L, Loscalzo J et al. (2015) Harrison’s Principles of Internal Medicine. McGraw-Hill Education
6. Maddock S. D., Circulis M. M., Callahan S. J., Keenan L. M., Pirozzi C. S., Raman S. M., Aberegg S. K. (2019) Pulmonary Lipid-Loaded Macrophages and Vaping. N Engl J Med 381: 1488–1489
7. Merza Y, Blessing A, Gompelmann D, Idzko M, Antoniewicz L (2023) When a Dry Nose Leads to Lung Disease. Journal of Pneumology. 3
8. Rieger C, Sennhauser F H, Zach M, von der Haardt H, Wahn U (1999) Pediatric Pneumology. Springer Verlag Berlin / Heidelberg 1053
9. Schwaiblmair M, Berghaus T, Haeckel T, Wagner T, von Scheidt W (2010) Lipid Pneumonia—An Underestimated Clinical Picture? Dtsch Med Wochenschr 135 (1/02) 27–31