Aspiration in Adults May Yield Varied Clinicoradiologic Presentations

Adult cases of aspiration examined via chest computed tomography scan and video-swallow evaluation yielded a broad spectrum of clinicoradiologic presentations, according to the results of a study recently published in CHEST.

Chest computed tomography scans were obtained from adults with aspiration identified on lung biopsy at the Mayo Clinic in Rochester, Minnesota. Demographic and clinical features such as risk factors for aspiration, diagnoses suspected before biopsy, imaging findings, and microbiologic data were analyzed and compared.

Among the 52 consecutive cases of aspiration identified on lung biopsy, the median patient age was 59 years. Of these, 63% were diagnosed by surgical biopsy and 37% by transbronchial biopsy, and only 35% of patients had aspiration suspected before the biopsy. Interestingly, 90% of the patients had ≥1 identifiable risk factor for aspiration such as gastroesophageal reflux disease, structurally abnormal gastrointestinal tract, or the use of consciousness-impairing medications. Chest computed tomography demonstrated a variety of parenchymal patterns including bronchiolitis, patchy consolidation, and mass.

The study authors wrote, “Aspiration is likely a common phenomenon and can occur in the absence of subjective or demonstrable swallowing difficulties.” They added, “In the presence of risk factors, aspiration needs to be considered in the differential diagnosis of an undiagnosed respiratory illness even in the presence of ‘atypical’ imaging findings.”

Reference

Ryu AJ, Navin PJ, Hu X, et al. Clinico-radiologic features of lung disease associated with aspiration identified on lung biopsy [published August 6, 2019]. CHEST. doi:10.1016/j.chest.2019.07.018