Presentation
Patient with stroke (complete right-sided MCA syndrome) is being referred to a neurovascular center, increasing shortness of breath throughout the transport.
Patient Data
Dependent consolidation of the lower lobes bilaterally and bronchial occlusions.
Consolidation of the lower lobes, on the left side raising higher than on the right side due to lower lobe anatomy.
Case Discussion
Dependent consolidation of the lower lobes bilaterally and bronchial occlusions, in the setting of a stroke patient (this means including dysphagia, fluctuating level of consciousness) with increasing shortness of breath and clinically suspected acute aspiration.
This patient was immediately intubated upon arrival suspecting aspiration and went on to have mechanical thrombectomy for his MCA occlusion first. The CT scan happened ~ 4 hours after initial onset of respiratory symptoms.
The correct but not widely used term for airspace opacification in an acute setting like this is 'aspiration pneumonitis', as the cause is alveolar filling and probably rapid reaction to the chemical stimulus rather than acute infection. Nevertheless, secondary bacterial superinfection may also develop later.
It should be noted that even acute aspiration pneumonitis does not always show a heavily gravitational dependent appearance like in this immobile, supine stroke patient.
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