Clinico-radiologic Features of Lung Disease Associated with Aspiration Identified on Lung Biopsy

Alexander J Ryu, Patrick J Navin, Xiaowen Hu, Eunhee S Yi, Thomas E Hartman, Jay H Ryu
Chest 2019 August 6

BACKGROUND: Aspiration-related lung diseases are commonly diagnosed presumptively based on the clinical context and radiologic findings. Limited data exist on the spectrum of clinico-radiologic presentations associated with aspiration.

METHODS: We reviewed all cases of aspiration identified on lung biopsy encountered at Mayo Clinic, Rochester, Minnesota, USA between 2003 and 2017. We analyzed demographic and clinical features including risk factors for aspiration, diagnoses suspected prior to biopsy, imaging findings, and microbiologic data.

RESULTS: We identified 52 consecutive adult cases of aspiration identified on lung biopsy (histologic presence of food or other particulate matter); median age 59 years (range, 22 to 79 years), 38% women, and five lung transplant recipients. Of these, 65% were diagnosed by surgical biopsy (including 4 cases of lobectomy) and 37% by transbronchial biopsy. Aspiration was clinically suspected prior to biopsy in only 35% of the subjects. Ninety percent of subjects had at least one identifiable risk factor for aspiration; gastroesophageal reflux disease was the most common (62%), followed by structurally abnormal esophago-gastric tract and the use of consciousness-impairing medications. Only 27% of patients reported dysphagia or choking. Chest CT demonstrated variety of parenchymal patterns including bronchiolitis (42%), patchy consolidation (19%), and mass (15%). Of 25 patients undergoing a video-swallow evaluation, only 14 (56%) demonstrated abnormal results with laryngeal penetration with or without aspiration. Microbial cultures obtained in 21 lung biopsy specimens yielded no pathogens.

CONCLUSIONS: Aspiration can occur in the absence of subjective or demonstrable swallowing difficulties and manifest a broad spectrum of clinico-radiologic presentations.


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