CHEST Guidelines-Lipoid-Pneumonia

Lipoid-Pneumonia_chest
Pdf Summary
Lipoid pneumonia, characterized by the accumulation of lipids in the lung alveoli, is an underdiagnosed condition with poorly understood natural history. It occurs in two forms: endogenous and exogenous. Endogenous lipoid pneumonia often results from bronchial obstruction and lipid storage diseases, whereas exogenous lipoid pneumonia (ELP) arises from inhalation or aspiration of oil-based substances and can be acute or chronic.<br /><br />Acute ELP follows significant, short-term exposure to lipids, leading to possible respiratory failure or death, but survivors typically recover fully. Chronic ELP develops from long-term exposure to oil-based products, initially documented nearly a century ago. Numerous substances, including nasal drops, lip balms, vaping materials, and cooking oils, have been implicated in ELP. Diagnosis is difficult due to nonspecific symptoms and various radiological patterns, requiring history-taking, CT imaging, biopsy, or bronchoalveolar lavage (BAL) evidence of lipids in the lung.<br /><br />A notable study by Samhouri et al. examined 34 patients with chronic ELP over a 32-year period. The advanced average age of 71 years and various causative agents, including fish oil supplements and nasal lubricants, were significant findings. Despite ceasing exposure, many patients had no improvement, and causative substances were often identified only after diagnosis. Consequently, some patients were misdiagnosed with lung cancer and underwent unnecessary surgery.<br /><br />This study highlights the need for awareness and thorough patient history-taking for potential oil exposures to optimize diagnosis. Special attention to CT imaging and attenuation values can aid in identifying ELP. Health professionals are urged to maintain high suspicion, especially in unexplained pulmonary infiltrates, to effectively diagnose lipoid pneumonia.
Keywords
lipoid pneumonia
endogenous
exogenous
acute ELP
chronic ELP
oil-based substances
diagnosis
Samhouri et al.
CT imaging
pulmonary infiltrates