Abstract: Exogenous lipoid pneumonia following hydrocarbon aspiration is an unusual but severe condition. This study aimed to summarize the cases of pneumonitis following fuel aspiration from a single center to serve as a useful reference for clinicians in the future. The clinical courses and outcomes of 11 patients with pneumonitis following fuel aspiration were collected and presented. Among them, 4 representative cases were described in detail to summarize the management experience of this disease, and these cases were analyzed to better understand the clinical features and management strategies of hydrocarbon pneumonitis following fuel aspiration. Almost all patients were found to present with cough and dyspnea, and the most common symptoms were dyspnea and chest pain. A high proportion (90.9%) of patients presented with bilateral lower pulmonary field involvement, and half of the patients showed pneumonic consolidation. One patient with irreversible lung injury received extracorporeal membrane oxygenation (ECMO) and a lung transplant. The other patients received oxygen support, antibiotics, steroids, and other supportive care. Antibiotics and steroids were the most commonly used treatments. While bronchoalveolar lavage (BAL) was beneficial for removing irritants, its utility could also be reduced due to significant risks. Finally, all patients had favorable outcomes. In conclusion, ELP was definitely harmful to patients' health, and hypoxemia was common among these patients. Supportive care, including antibiotics, steroids and respiratory support, was the main treatment modality. It is recommended that the decision to employ BAL is made selectively. ECMO serves as a critical bridge to recovery or transplantation, and patients with timely and efficient treatment usually had a positive outcome.