Objective To evaluate the clinical, radiological and pathological manifestations of lipoid pneumonia, to improve the diagnosis of this rare disease. Methods Retrospective analysis of clinical data of 19 cases with confirmed lipoid pneumonia was conducted. Results There was 13 male and 6 female patients with an average age of 54. 4 years ranging from 24 to 71 years. Lipoid pneumonia presented a chronic clinical course with few physical signs. The main complaints included cough, expectation, bloody phlegmand chest pain. Finding of chest mass in routine physical examination was also a common reason for doctor visiting. Radiological features of lipoid pneumonia could be non-specific, usually presenting mass shadow in the chest, with lymph nodes enlargement in some cases. Eighteen cases were diagnosed by the histopathology of pulmonary tissue and one case was diagnosed through a combination of bronchoscopy, thoracoscopy and CT-guided percutaneous lung puncture biopsy. Histopathological finding showed accumulation of foamy macrophages in the alveolar spaces. Conclusions The clinical and radiological manifestations of lipoid pneumonia are non-specific. Histopathological examination for diagnosis is essential. If the medical therapy is not responsive, pulmonary lobectomy might be necessary.