EXOGENOUS LIPOID PNEUMONIA IN PEDIATRIC PRACTICE
DOI:
https://doi.org/10.11603/24116-4944.2026.1.16383Keywords:
exogenous lipoid pneumonia, EVALI, aspiration, lipid-laden macrophages, vitamin E acetateAbstract
The aim of the study – to systematize knowledge regarding two ELP phenotypes, identify key radiological predictors, and formulate an adapted diagnostic algorithm based on a systematic analysis of literature and clinical cases (ranging from classic descriptions of mineral oil aspiration to EVALI outbreaks).
Materials and Methods. A systematic analysis of scientific literature from 2000–2025 was conducted using PubMed, Scopus, and Web of Science databases, focusing on exogenous lipoid pneumonia in children. Case reports and systematic reviews were analyzed to identify and compare two distinct clinical patterns: chronic aspiration form and acute e-cigarette or vaping product use-associated lung injury (EVALI).
Results and Discussion. The analysis confirms the existence of two distinct scenarios. The first is the “chronic aspiration” form, characteristic of infants and young children with risk factors (GERD, neurological deficits) or specific cultural practices (nasal oil instillation). Radiologically, it manifests as consolidation with negative (“fat”) density. The second is the “acute inhalational” form (EVALI) in adolescents, presenting as chemical pneumonitis with symptoms mimicking COVID-19 and the “crazy-paving” pattern on CT scans.
Conclusions. ELP remains a “great imitator” in pulmonology. The key to verification lies in the combination of targeted history analysis (identifying “hidden” lipids) and specific interpretation of CT patterns, confirmed by bronchoalveolar lavage cytology.
References
1. Agrawal, A., Visconti, A., Savas, J. G., & Jaber, H. W. (2020). Vaping-associated pulmonary injury: A review of ICU admissions and a radiological perspective. Radiology Case Reports, 15(4), 309–312. https://doi.org/10.1016/j.radcr.2020.01.002
2. Annobil, S. H., El Tahir, M., Kameswaran, M., & Morad, N. (1997). Olive oil aspiration pneumonia (lipoid) in children. Tropical Medicine & International Health, 2(4), 383–388. https://doi.org/10.1046/j.1365-3156.1997.d01-292.x
3. Bandla, S. R., Sferra, T. J., & Pfefferkorn, M. D. (2013). Exogenous lipoid pneumonia in children: A case series. Indian Pediatrics, 50(1), 111–113.
4. Bhatia, R., Weng, J., Sulton, A., & Kattan, M. (2021). Longitudinal follow-up of lung function in adolescents with EVALI. Chest, 160(4 Suppl.), A1234. https://doi.org/10.1016/j.chest.2021.07.1130
5. Blount, B. C., Karwowski, M. P., Shields, P. G., Morel-Espinosa, M., Valentin-Blasini, L., Gardner, M., ..., & Lung Injury Response Laboratory Working Group. (2020). Vitamin E acetate in bronchoalveolar lavage fluid associated with EVALI. The New England Journal of Medicine, 382(8), 697–705. https://doi.org/10.1056/NEJMoa1916433
6. Butt, Y. M., Smith, M. L., Tazelaar, H. D., Vaszar, L. T., Swanson, K. L., Cecchini, M. J., Boland, J. M., Bois, M. C., Boyum, J. H., Colby, T. V., Kligerman, S. J., Larsen, B. T., & Hariri, L. P. (2019). Pathology of vaping-associated lung injury. The New England Journal of Medicine, 381(18), 1780–1781. https://doi.org/10.1056/NEJMc1913069
7. Gondouin, A., Manzoni, P., Ranfaing, E., Brun, J., Cadranel, J., Sadoun, D., Cordier, J.-F., & Dalphin, J.-C. (1996). Exogenous lipid pneumonia: A retrospective multicentre study of 44 cases in France. European Respiratory Journal, 9(7), 1463–1469. https://doi.org/10.1183/09031936.96.09071463
8. Hadda, V., & Khilnani, G. C. (2010). Lipoid pneumonia: An overview. Expert Review of Respiratory Medicine, 4(6), 799–807. https://doi.org/10.1586/ers.10.74
9. Henry, T. S., Kligerman, S. J., Raptis, C. A., Mann, H., Sechrist, J. W., & Kanne, J. P. (2019). Imaging of vaping-associated lung injury. The New England Journal of Medicine, 381(15), 1486–1487. https://doi.org/10.1056/NEJMc1911995
10. Kligerman, S. J., Franks, T. J., Galvin, J. R., From the Radiologic Pathologic Conference Faculty, & Henry, T. S. (2020). Radiologic, pathologic, and clinical outcomes of vaping-associated lung injury. Radiology, 296(1), E1–E12. https://doi.org/10.1148/radiol.2020192585
11. Krishnasamy, V. P., Hallowell, B. D., Ko, J. Y., Board, A., Hartnett, K. P., Salvatore, P. P., Danielson, M., Kite-Powell, A., Twentyman, E., Kim, L., Cyrus, A., Gundlapalli, A. V., Meaney-Delman, D., & Lung Injury Response Epidemiology/Surveillance Task Force. (2020). Update: Characteristics of a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury—United States, August 2019–January 2020. MMWR. Morbidity and Mortality Weekly Report, 69(3), 90–94. https://doi.org/10.15585/mmwr.mm6903e2
12. Kurlandsky, L. E., Vaandrager, V., & Davy, C. L. (1992). Lipoid pneumonia in association with gastroesophageal reflux. Pediatric Pulmonology, 13(3), 184–188. https://doi.org/10.1002/ppul.1950130310
13. Layden, J. E., Ghinai, I., Pray, I., Kimball, A., Layer, M., Tenforde, M. W., Navon, L., Hoots, B., Salvatore, P. P., Elderbrook, M., Haupt, T., Kanne, J., Patel, M. T., Saathoff-Huber, L., King, B. A., Schier, J. G., Mikosz, C. A., Meiman, J., & the Illinois and Wisconsin LIMS Investigation Team. (2020). Pulmonary illness related to e-cigarette use in Illinois and Wisconsin: Final report. The New England Journal of Medicine, 382(10), 903–916. https://doi.org/10.1056/NEJMoa1911614
14. Maddox, C., Paul, D., Mitchell, R. M., & Jhaveri, P. (2020). Pulmonary lipid-laden macrophages and vaping-associated lung injury. The New England Journal of Medicine, 382(10), 981–982. https://doi.org/10.1056/NEJMc1916398
15. Marangu, D., Gray, D., Vanker, A., & Zampoli, M. (2020). Exogenous lipoid pneumonia in children: A systematic review. Paediatric Respiratory Reviews, 33, 45–51. https://doi.org/10.1016/j.prrv.2019.01.001
16. Marchiori, E., Zanetti, G., Mano, C. M., & Hochhegger, B. (2011). Exogenous lipoid pneumonia: Clinical and radiological manifestations. Respiratory Medicine, 105(5), 659–666. https://doi.org/10.1016/j.rmed.2010.12.001
17. Marom, E. M., McAdams, H. P., Erasmus, J. J., & Goodman, P. C. (2004). The many faces of exogenous lipoid pneumonia. American Journal of Roentgenology, 183(3), 749–755. https://doi.org/10.2214/ajr.183.3.1830749
18. Pambuccian, S. E. (2020). Testing for lipid-laden macrophages in bronchoalveolar lavage fluid to diagnose vaping-associated pulmonary injury: Are we there yet? Journal of the American Society of Cytopathology, 9(1), 1–8. https://doi.org/10.1016/j.jasc.2019.10.002
19. Park, H., Ha, K., & Lee, J. (2017). Whole lung lavage in a child with exogenous lipoid pneumonia: A case report. Respiratory Medicine Case Reports, 21, 18–20. https://doi.org/10.1016/j.rmcr.2017.03.013
20. Rao, D. R., Maple, K. L., Daulton, R. S., Sonti, R. G., & Mosha, M. (2022). Diagnosis of EVALI in adolescents during the COVID-19 pandemic. Hospital Pediatrics, 12(5), 538–545. https://doi.org/10.1542/hpeds.2021-006277
21. Sias, S. M., Daltro, P. A., Marchiori, E., & Ferreira, A. S. (2009). Clinic and radiological improvement of lipoid pneumonia with multiple bronchoalveolar lavages. Pediatric Pulmonology, 44(4), 309–315. https://doi.org/10.1002/ppul.20918
22. Zanetti, G., Marchiori, E., Gasparetto, T. D., Escuissato, D. L., & Souza, A. S., Jr. (2007). Lipoid pneumonia in children following aspiration of mineral oil used in the treatment of constipation: High-resolution CT findings in 17 patients. Pediatric Radiology, 37(11), 1135–1139. https://doi.org/10.1007/s00247-007-0603-1
23. Dobrovolska, L. I., Boiarchuk, O. R., Hariyan, T. V., & Hlushko, K. T. (2020). Dosvid borotby z veipinhom ta yoho naslidkamy sered ditei ta molodi [Experience of combating vaping and its consequences among children and youth]. Visnyk Medychnykh i Biolohichnykh Doslidzhen, 3, 153–160. https://doi.org/10.11603/bmbr.2706-6290.2020.3.11452
24. Mamenko, M., Romankevych, I., Rakovska, L., Lapii, F., & Katilov, O. (2019). Ofitsiina pozytsiia HS "Ukrainska Akademiia Pediatrychnykh Spetsialnostei" shchodo potentsiinoi nebezpeky vykorystannia elektronnykh syharet ditmy ta pidlitkamy [Official position of the Public Union "Ukrainian Academy of Pediatric Specialties" regarding the potential danger of electronic cigarette use by children and adolescents]. Suchasna Pediatriia. Ukraina, 8(104), 6–8. https://doi.org/10.15574/SP.2019.104.6
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