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Spectrum of Aspiration-Related Disorders
Tomás Franquet, MD, PhD; Gerald F. Abbott, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Aspiration-related disorders: Pulmonary diseases resulting from aspiration of solid &/or liquid materials into airways and lungs
              • Aspiration pneumonia
                • Pulmonary infection caused by aspiration of oropharyngeal secretions colonized by pathogenic bacteria
                • Usually manifests as community-acquired pneumonia (CAP)
              • Aspiration pneumonitis (Mendelson syndrome)
                • Acute lung injury caused by aspiration of sterile gastric contents
            • Specific aspiration syndromes
              • Foreign bodies: Most common endobronchial lesion in children; food particles (vegetables) and tooth fragments (elderly)
                • Most commonly lodge in mainstem and lobar bronchi
              • Aspiration of barium sulfate: Mild reaction in early phase due to inert character of barium
                • Radiopaque material within airways ("tree-in-bud")
              • Exogenous lipoid pneumonia: Repeated aspiration or inhalation of mineral oil or oily nose drops in adults and cod liver oil and milk in children
              • Near drowning: Pulmonary edema after acute aspiration of massive amounts of fresh or salt water
                • Combination of aspiration and noncardiogenic edema
                • Secondary pneumonia may occur depending on composition of aspirate
              • Hydrocarbon pneumonia: Accidental, intentional, or occupational aspiration of various toxic substances
                • Children: Furniture polish
                • Hydrocarbon containing fluid: Petroleum-based fluids
                • Flame swallowers (known as fire-eater pneumonia)
              • Diffuse aspiration bronchiolitis: Recurrent aspiration; typically elderly patients with neurologic disorders, dementia, or oropharyngeal dysphagia
                • Disseminated tree-in-bud opacities with patchy lobular consolidations
                • Lentil pneumonia: Subset of diffuse aspiration bronchiolitis; granulomatous pneumonitis caused by aspiration of leguminous material (e.g., lentils, beans, peas)

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • Imaging Recommendations

                  • MR Findings

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Image Interpretation Pearls

                                  Selected References

                                  1. DiBardino DM et al: Aspiration pneumonia: a review of modern trends. J Crit Care. 30(1):40-8, 2015
                                  2. Marik PE: Pulmonary aspiration syndromes. Curr Opin Pulm Med. 17(3):148-54, 2011
                                  3. Marchiori E et al: Lipoid pneumonia in 53 patients after aspiration of mineral oil: comparison of high-resolution computed tomography findings in adults and children. J Comput Assist Tomogr. 34(1):9-12, 2010
                                  4. Rossi SE et al: "Crazy-paving" pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics 23: 1509-19, 2003
                                  5. Franquet T et al: Aspiration diseases: Findings, pitfalls, and differential diagnosis. Radiographics 20:673-85, 2000
                                  6. Kim KI et al: Near drowning: thin-section CT findings in six patients. J Comput Assist Tomogr. 24(4):562-6, 2000
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Clinical Issues

                                        • Diagnostic Checklist

                                          TERMINOLOGY

                                          • Definitions

                                            • Aspiration-related disorders: Pulmonary diseases resulting from aspiration of solid &/or liquid materials into airways and lungs
                                              • Aspiration pneumonia
                                                • Pulmonary infection caused by aspiration of oropharyngeal secretions colonized by pathogenic bacteria
                                                • Usually manifests as community-acquired pneumonia (CAP)
                                              • Aspiration pneumonitis (Mendelson syndrome)
                                                • Acute lung injury caused by aspiration of sterile gastric contents
                                            • Specific aspiration syndromes
                                              • Foreign bodies: Most common endobronchial lesion in children; food particles (vegetables) and tooth fragments (elderly)
                                                • Most commonly lodge in mainstem and lobar bronchi
                                              • Aspiration of barium sulfate: Mild reaction in early phase due to inert character of barium
                                                • Radiopaque material within airways ("tree-in-bud")
                                              • Exogenous lipoid pneumonia: Repeated aspiration or inhalation of mineral oil or oily nose drops in adults and cod liver oil and milk in children
                                              • Near drowning: Pulmonary edema after acute aspiration of massive amounts of fresh or salt water
                                                • Combination of aspiration and noncardiogenic edema
                                                • Secondary pneumonia may occur depending on composition of aspirate
                                              • Hydrocarbon pneumonia: Accidental, intentional, or occupational aspiration of various toxic substances
                                                • Children: Furniture polish
                                                • Hydrocarbon containing fluid: Petroleum-based fluids
                                                • Flame swallowers (known as fire-eater pneumonia)
                                              • Diffuse aspiration bronchiolitis: Recurrent aspiration; typically elderly patients with neurologic disorders, dementia, or oropharyngeal dysphagia
                                                • Disseminated tree-in-bud opacities with patchy lobular consolidations
                                                • Lentil pneumonia: Subset of diffuse aspiration bronchiolitis; granulomatous pneumonitis caused by aspiration of leguminous material (e.g., lentils, beans, peas)

                                          IMAGING

                                          • General Features

                                            • Radiographic Findings

                                              • CT Findings

                                                • Imaging Recommendations

                                                  • MR Findings

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        • Microscopic Features

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. DiBardino DM et al: Aspiration pneumonia: a review of modern trends. J Crit Care. 30(1):40-8, 2015
                                                                  2. Marik PE: Pulmonary aspiration syndromes. Curr Opin Pulm Med. 17(3):148-54, 2011
                                                                  3. Marchiori E et al: Lipoid pneumonia in 53 patients after aspiration of mineral oil: comparison of high-resolution computed tomography findings in adults and children. J Comput Assist Tomogr. 34(1):9-12, 2010
                                                                  4. Rossi SE et al: "Crazy-paving" pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics 23: 1509-19, 2003
                                                                  5. Franquet T et al: Aspiration diseases: Findings, pitfalls, and differential diagnosis. Radiographics 20:673-85, 2000
                                                                  6. Kim KI et al: Near drowning: thin-section CT findings in six patients. J Comput Assist Tomogr. 24(4):562-6, 2000