Mendelson syndrome

The portable chest X-ray demonstrates extensive, ill-defined, bilateral ground glass opacity and infiltrates. There is a wide differential diagnosis including ARDS, cardiogenic and non-cardiogenic pulmonary oedema, and atypical infection including COVID-19 pneumonia and PJP.

CT scanogram demonstrates persistent infiltrates. There is however significant radiological improvement with supportive fluid, antibiotic and oxygenation therapy within 22 hours of the initial anaesthetic.

There is a type I sliding hiatal hernia with fluid and gastric contents within the oesophagus suggesting gastro-oesophageal reflux and alluding to the cause of the acute aspiration pneumonitis experienced during general anaesthesia. There is intermittent reflux even between the non-contrast and post-contrast phases in a recumbent position during CT performance as demonstrated within the oesophagus between the 2 phases.

There are typical changes with the posterior and dependent segments of the right upper lobe, right middle lobe, and left upper lobe including the singular segment. These include a combination of tree-in-bud within the left upper lobe, and ground glass opacity within the rest of the affected segments.

There is subsegmental atelectasis within the right lower lobe often a normal post recent anaesthetic finding.

There are no aspirated contents within the airways.

Reformated and annotated images show the type I sliding hiatal hernia and gasto-oespohageal reflux with a variable volume of gastric contents within the upper thoracic oesophagus.