pulmonary disorders
Aspiration Pneumonitis and Pneumonia
Diagnosis
Chest x-ray For aspiration pneumonia, chest x-ray shows an infiltrate, frequently but not exclusively, in the dependent lung segments, ie, the superior or posterior basal segments of a lower lobe or the posterior segment of an upper lobe. For aspiration-related lung abscess, chest x-ray may show a cavitary lesion. Contrast-enhanced computed tomography (CT) is more sensitive and specific for lung abscess and will show a round lesion filled with fluid or with an air-fluid level. Aspiration pneumonitis and pneumonia are distinguished by their clinical course and are indistinguishable by imaging. In patients with oil or petroleum jelly aspiration, chest x-ray findings vary; consolidation, cavitation, interstitial or nodular infiltrates, pleural effusion, and other changes may be slowly progressive. A CT scan can show fat attenuation within the consolidative opacities and nodules. Signs of ongoing aspiration may include frequent throat clearing or a wet-sounding cough after eating. Sometimes no signs are present, and ongoing aspiration is only diagnosed via modified barium esophagography done to rule out an underlying swallowing disorder. Selected patients with unexplained aspiration pneumonitis and aspiration pneumonia should be tested for an underlying swallowing disorder. 