Aspiration bronchiolitis, or diffuse aspiration bronchiolitis, is a condition characterised by a chronic inflammation of bronchioles caused by recurrent aspiration of foreign particles.
The onset of aspiration bronchiolitis can be more insidious than aspiration pneumonia, and in half of the patients, episodes of aspiration can be unrecognised 3. Patients may have a chronic cough.
It is characterised by a chronic inflammatory reaction to repeatedly aspirated foreign particles in the bronchioles.
- neurologic disorders: ~ 50% 3
- dementia: ~50 3
Aspiration bronchiolitis may be seen as unilateral or bilateral foci of 1,6:
- branching areas of increased attenuation with a tree-in-bud change
- centrilobular nodules
- mottled, poorly defined acinar areas of increased attenuation.
Consolidation is not a major radiologic finding.
Treatment and prognosis
A chronic cough in aspiration bronchiolitis usually does not respond to β-adrenergic bronchodilators or to inhaled steroids. The swallowing rehabilitation and temporally intravenous alimentation are considered the most effective way to reduce the symptoms 7.
If features are diffuse consider:
- diffuse panbronchiolitis from another (non-aspiration) cause
As a broader differential on CT, consider other forms of bronchiolitis.
- 1. Franquet T, Giménez A, Rosón N et-al. Aspiration diseases: findings, pitfalls, and differential diagnosis. Radiographics. 2000;20 (3): 673-85. Radiographics (full text) - Pubmed citation
- 2. Marik PE. Pulmonary aspiration syndromes. Curr Opin Pulm Med. 2011;17 (3): 148-54. doi:10.1097/MCP.0b013e32834397d6 - Pubmed citation
- 3. Matsuse T, Oka T, Kida K et-al. Importance of diffuse aspiration bronchiolitis caused by chronic occult aspiration in the elderly. Chest. 01;110 (5): 1289-93. doi:10.1378/chest.110.5.1289 - Pubmed citation
- 4. Janoski MM, Raymond GS, Puttagunta L et-al. Psyllium aspiration causing bronchiolitis: radiographic, high-resolution CT, and pathologic findings. AJR Am J Roentgenol. 2000;174 (3): 799-801. doi:10.2214/ajr.174.3.1740799 - Pubmed citation
- 5. Boiselle PM, Lynch D. CT of the Airways. Humana Press. (2008) ISBN:1588298485. Read it at Google Books - Find it at Amazon
- 6. Giménez A, Franquet T, Erasmus JJ et-al. Thoracic complications of esophageal disorders. Radiographics. 2003;22 Spec No: S247-58. Pubmed citation
- 7. Teramoto S, Ishii T, Yamamoto H et-al. Significance of chronic cough as a defence mechanism or a symptom in elderly patients with aspiration and aspiration pneumonia. Eur. Respir. J. 2005;25 (1): 210-1. Eur. Respir. J. (full text) - doi:10.1183/09031936.04.00111404 - Pubmed citation