Lipoid pneumonia: a narrative review of recent developments

Lipoid pneumonia is an uncommon pulmonary condition resulting from the accumulation of lipids within the alveolar spaces. It is classified as “exogenous” when caused by aspiration or inhalation of lipid-containing substances or “endogenous” when lipids accumulate from cellular breakdown within the body. Despite increasing recognition, lipoid pneumonia remains diagnostically challenging due to nonspecific clinical and radiological presentations that often mimic malignancy or infectious processes. This narrative review synthesizes recent developments in the understanding of lipoid pneumonia, with particular emphasis on epidemiology, pathophysiology, diagnostic approaches, treatment strategies, and emerging etiologies, including vaping-related lung injury. Critically, the evidence base for lipoid pneumonia consists predominantly of case reports, case series, and small retrospective studies, with no randomized controlled trials or prospective cohort studies available to guide clinical decision-making. The natural history remains poorly characterized, and optimal therapeutic interventions beyond supportive care and elimination of exposure have not been rigorously evaluated. This review highlights key knowledge gaps and proposes directions for future research to improve the diagnosis and management of this challenging condition.