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Aspiration
Carlos S. Restrepo, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Tracheoesophageal fistula (TEF)
            • Bronchoesophageal fistula (BEF)
          • Synonyms

            • Aspiration pneumonia: Lung infection caused by aspiration of colonized oropharyngeal secretions
            • Aspiration pneumonitis: Acute lung injury caused by aspiration of material inherently toxic to lungs
            • Aspiration bronchiolitis: Chronic inflammatory reaction to recurrent aspirated foreign particles in bronchioles
          • Definitions

            • Inhalation of oropharyngeal or gastric content into larynx or lower respiratory tract with resultant various types of aspiration syndromes
              • Aspiration pneumonia: Most hospital-acquired infections
                • Lentil aspiration pneumonia: Leguminous material (lentils, beans, peas)
                • Fistulas between esophagus and trachea, bronchi or lung
                  • Congenital TEF
                  • Esophageal cancer (5-10%)
              • Aspiration pneumonitis
                • Mendelson syndrome
                  • Aspirated sterile gastric content with pH < 2.5
                  • Peripartum, anesthesia, decreased level of consciousness
                  • Severity depends on aspirate pH and volume
                • Exogenous lipoid pneumonia
                  • Mineral oil or related substances
                • Hydrocarbon aspiration pneumonia
                  • Children: Accidental poisoning
                  • Fire-eaters: Hydrocarbon-containing fluids (petroleum)
              • Aspiration of inert fluids or particulates
                • Foreign bodies: Food particles (children); tooth fragments (older adults)
                • Foreign body aspiration commonly associated with atelectasis
                • Near drowning: Massive amount of fresh or salt water
              • Aspiration bronchiolitis
                • Often referred to as diffuse aspiration bronchiolitis
                • Obliterative bronchiolitis and gastroesophageal reflux (mimics asthma)
                • Common, often overlooked

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • Nuclear Medicine Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          CLINICAL ISSUES

                          • Presentation

                            Selected References

                            1. Little BP et al: Direct and indirect CT imaging features of esophago-airway fistula in adults. J Thorac Dis. 12(6):3157-66, 2020
                            2. Mandell LA et al: Aspiration pneumonia. N Engl J Med. 380(7):651-63, 2019
                            3. Rodriguez AE et al: New perspectives in aspiration community acquired Pneumonia. Expert Rev Clin Pharmacol. 12(10):991-1002, 2019
                            4. Lenz CJ et al: Esophagorespiratory fistulas: survival and outcomes of treatment. J Clin Gastroenterol. 52(2):131-6, 2018
                            5. Winningham PJ et al: Bronchiolitis: a practical approach for the general radiologist. Radiographics. 37(3):777-94, 2017
                            6. Yan GW et al: A case report and literature review of barium sulphate aspiration during upper gastrointestinal examination. Medicine (Baltimore). 96(47):e8821, 2017
                            7. Hundemer GL et al: Large-volume barium aspiration. Proc (Bayl Univ Med Cent). 28(2):183-4, 2015
                            8. Miyashita N et al: Detection failure rate of chest radiography for the identification of nursing and healthcare-associated pneumonia. J Infect Chemother. 21(7):492-6, 2015
                            9. Zhang L et al: Barium sulfate aspiration: severe chemical pneumonia induced by a massive reflux of contrast medium during small bowel barium enema. Forensic Sci Int. 253:e16-9, 2015
                            10. Prather AD et al: Aspiration-related lung diseases. J Thorac Imaging. 29(5):304-9, 2014
                            11. Katabathina VS et al: Nonvascular, nontraumatic mediastinal emergencies in adults: a comprehensive review of imaging findings. Radiographics. 31(4):1141-60, 2011
                            12. Marik PE: Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 344(9):665-71, 2001
                            13. Franquet T et al: Aspiration diseases: findings, pitfalls, and differential diagnosis. Radiographics. 20(3):673-85, 2000
                            14. Marom EM et al: The many faces of pulmonary aspiration. AJR Am J Roentgenol. 172(1):121-8, 1999
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Imaging

                                • Top Differential Diagnoses

                                  • Clinical Issues

                                    TERMINOLOGY

                                    • Abbreviations

                                      • Tracheoesophageal fistula (TEF)
                                      • Bronchoesophageal fistula (BEF)
                                    • Synonyms

                                      • Aspiration pneumonia: Lung infection caused by aspiration of colonized oropharyngeal secretions
                                      • Aspiration pneumonitis: Acute lung injury caused by aspiration of material inherently toxic to lungs
                                      • Aspiration bronchiolitis: Chronic inflammatory reaction to recurrent aspirated foreign particles in bronchioles
                                    • Definitions

                                      • Inhalation of oropharyngeal or gastric content into larynx or lower respiratory tract with resultant various types of aspiration syndromes
                                        • Aspiration pneumonia: Most hospital-acquired infections
                                          • Lentil aspiration pneumonia: Leguminous material (lentils, beans, peas)
                                          • Fistulas between esophagus and trachea, bronchi or lung
                                            • Congenital TEF
                                            • Esophageal cancer (5-10%)
                                        • Aspiration pneumonitis
                                          • Mendelson syndrome
                                            • Aspirated sterile gastric content with pH < 2.5
                                            • Peripartum, anesthesia, decreased level of consciousness
                                            • Severity depends on aspirate pH and volume
                                          • Exogenous lipoid pneumonia
                                            • Mineral oil or related substances
                                          • Hydrocarbon aspiration pneumonia
                                            • Children: Accidental poisoning
                                            • Fire-eaters: Hydrocarbon-containing fluids (petroleum)
                                        • Aspiration of inert fluids or particulates
                                          • Foreign bodies: Food particles (children); tooth fragments (older adults)
                                          • Foreign body aspiration commonly associated with atelectasis
                                          • Near drowning: Massive amount of fresh or salt water
                                        • Aspiration bronchiolitis
                                          • Often referred to as diffuse aspiration bronchiolitis
                                          • Obliterative bronchiolitis and gastroesophageal reflux (mimics asthma)
                                          • Common, often overlooked

                                    IMAGING

                                    • General Features

                                      • Radiographic Findings

                                        • CT Findings

                                          • Nuclear Medicine Findings

                                            • Imaging Recommendations

                                              DIFFERENTIAL DIAGNOSIS

                                                PATHOLOGY

                                                • General Features

                                                  • Gross Pathologic & Surgical Features

                                                    CLINICAL ISSUES

                                                    • Presentation

                                                      Selected References

                                                      1. Little BP et al: Direct and indirect CT imaging features of esophago-airway fistula in adults. J Thorac Dis. 12(6):3157-66, 2020
                                                      2. Mandell LA et al: Aspiration pneumonia. N Engl J Med. 380(7):651-63, 2019
                                                      3. Rodriguez AE et al: New perspectives in aspiration community acquired Pneumonia. Expert Rev Clin Pharmacol. 12(10):991-1002, 2019
                                                      4. Lenz CJ et al: Esophagorespiratory fistulas: survival and outcomes of treatment. J Clin Gastroenterol. 52(2):131-6, 2018
                                                      5. Winningham PJ et al: Bronchiolitis: a practical approach for the general radiologist. Radiographics. 37(3):777-94, 2017
                                                      6. Yan GW et al: A case report and literature review of barium sulphate aspiration during upper gastrointestinal examination. Medicine (Baltimore). 96(47):e8821, 2017
                                                      7. Hundemer GL et al: Large-volume barium aspiration. Proc (Bayl Univ Med Cent). 28(2):183-4, 2015
                                                      8. Miyashita N et al: Detection failure rate of chest radiography for the identification of nursing and healthcare-associated pneumonia. J Infect Chemother. 21(7):492-6, 2015
                                                      9. Zhang L et al: Barium sulfate aspiration: severe chemical pneumonia induced by a massive reflux of contrast medium during small bowel barium enema. Forensic Sci Int. 253:e16-9, 2015
                                                      10. Prather AD et al: Aspiration-related lung diseases. J Thorac Imaging. 29(5):304-9, 2014
                                                      11. Katabathina VS et al: Nonvascular, nontraumatic mediastinal emergencies in adults: a comprehensive review of imaging findings. Radiographics. 31(4):1141-60, 2011
                                                      12. Marik PE: Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 344(9):665-71, 2001
                                                      13. Franquet T et al: Aspiration diseases: findings, pitfalls, and differential diagnosis. Radiographics. 20(3):673-85, 2000
                                                      14. Marom EM et al: The many faces of pulmonary aspiration. AJR Am J Roentgenol. 172(1):121-8, 1999