[Dysphagia] Franquet et al

[eripley at yahoo.com (Irene Campbell-Taylor)]

Having previously cited this article, I strongly recommend it:

 


Aspiration Diseases: Findings, Pitfalls, and Differential Diagnosis1 Radiographics. 2000;20:673-685.)
Tom?s Franquet, MD, Ana Gim?nez, MD, Nuria Ros?n, MD, Sof?a Torrubia, MD, Jos? M. Sabat?, MD and Carmen P?rez, MD

 

http://radiographics.rsnajnls.org/cgi/reprint/20/3/673

 

 Abstract

The aspiration of different substances into the airways and lungs may cause a variety of pulmonary complications. These disease entities most commonly involve the posterior segment of the upper lobes and the superior segment of the lower lobes. Esophagography and computed tomography (CT) are especially useful in the evaluation of aspiration disease related to tracheoesophageal or tracheopulmonary fistula. Foreign body aspiration typically occurs in children and manifests as obstructive lobar or segmental overinflation or atelectasis. An extensive, patchy bronchopneumonic pattern may be observed in patients following massive aspiration of gastric acid or water. CT is the modality of choice in establishing the diagnosis of exogenous lipoid pneumonia, which can result from aspiration of hydrocarbons or of mineral oil or a related substance. Aspiration of infectious material manifests as necrotizing consolidation and abscess formation. The relatively low diagnostic accuracy of chest
 radiography in aspiration diseases can be improved with CT and by being familiar with the clinical settings in which specific complications are likely to occur. Recognition of the varied clinical and radiologic manifestations of these disease entities is imperative for prompt, accurate diagnosis, resulting in decreased morbidity and mortality rates.

In this article, we discuss and illustrate the spectrum of radiologic manifestations, diagnostic pitfalls, and differential diagnoses associated with a variety of aspiration diseases. These include diseases associated with tracheoesophageal or tracheopulmonary fistula; diseases caused by aspiration of foreign bodies, liquids, or infectious material; and other aspiration diseases (lentil aspiration pneumonia, aspiration bronchiolitis, obliterative bronchiolitis). 

With respect to the aspiration of water, for example, they say:
Near Drowning
The acute aspiration of massive amounts of water produces a pulmonary edema that is radiographically indistinguishable from pulmonary edema from other causes. The clinical significance of near drowning depends more on the volume of water aspirated than on whether the aspirate is fresh water or salt water. 
Classic chest radiographic findings in severe near drowning consist of alveolar edema with extensive "fluffy" areas of increased opacity that tend to coalesce throughout both lungs. In mild near drowning, findings range from normal to confluent irregular perihilar areas of increased opacity in a subsegmental or segmental distribution with peripheral sparing. Pneumonia may be a complication of the aspiration of either fresh or salt water, and, depending on the water source, may be caused by a variety of microorganisms including bacteria, fungi, and mycobacteria. (i.e. not the water itself but its microbial content.)


Dr I Campbell-Taylor
Clinical Neuroscientist
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