Acute aspiration pneumonitis

Case contributed by Yves Leonard Voss

Presentation

Patient with stroke (complete right-sided MCA syndrome) is being referred to a neurovascular centre, increasing shortness of breath throughout the transport.

Patient Data

Age: 80 years
Gender: Male
CT

Dependent consolidation of the lower lobes bilaterally and bronchial occlusions.

X-ray

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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Case information

rID: 55642
Case created: 19th Sep 2017
Last edited: 25th Sep 2017
System: Chest
Inclusion in quiz mode: Included

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