CTICasesExogenous Lipoid Pneumonia
Imaging findings
A patient referred to an interstitial lung disease clinic had right upper lobe volume loss with elevation of the minor fissure and near-complete atelectasis of the anterior and posterior segments on serial CTs. Soft-tissue windows revealed the opacity to be macroscopic fat, a finding missed at an outside hospital that had instead pursued a PET scan (which was hot), a non-diagnostic CT-guided biopsy, and ultimately an open lung biopsy confirming exogenous lipoid pneumonia; the patient had a remote history of mineral oil use for constipation and an incidental large paraesophageal hernia, and pathology also showed associated fibrosis and cut-off bronchi.
Key takeaways
Macroscopic fat attenuation within a consolidative or atelectatic opacity on soft-tissue windows is the key to diagnosing exogenous lipoid pneumonia non-invasively and avoiding an unnecessary PET/biopsy workup, and a remote history of oil-based aspiration (such as chronic mineral oil use) should always be sought; this case was unusual both for its localization to a single lobe and for the degree of associated volume loss/fibrosis it produced.
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