Chronic exogenous lipoid pneumonia

Case contributed by Joan Perelló Garcia
Diagnosis almost certain

Presentation

18-month history of dry cough and hemoptysis. Permanent tracheostomy placed 23 years ago after laryngectomy for tumor.

Patient Data

Age: 70 years
Gender: Male

Bronchocentric consolidations are in the left lower lobe with central fat density and peripheral reticular bands.

No lymphadenopathy or effusion. 

Case Discussion

Lipoid pneumonia can be classified as exogenous or endogenous depending on the source of the accumulating lipid. This case represents illustrates a typical presentation of chronic exogenous lipoid pneumonia, with central fatty attenuation and irregular, spiculated borders due to chronic inflammation and secondary fibrosis. ​

Chronic exogenous lipoid pneumonia can result from chronic aspiration in patients with swallowing disorders, or from the chronic use of mineral oil, petroleum based lubricants, decongestants or even lip gloss.​ The clinical context is important, as both hamartomas and metastases from primary extrathoracic liposarcomas can contain fat.

Our patient reported long-term use of a petroleum based topical ointment to moisten the tracheostomy site. This was discontinued following diagnosis and a chest x-ray performed 6 months later showed clearing of the left lower lobe.

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