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[Dysphagia] aspiration pneumonia
Well, often we just guess. If we guess aspiration, and it was not a
one-time deal such as emesis while airway unproteceted, we'd look for a
source of aspiration either from below (reflux) or above (swallowing or
secretions.) VFSS and radionuclide studies are usually what are used to
help with that process. Given all that comes up negative, even if it is
right middle or lower, we'd have to consider that it was not aspiration
and move along with additional lung studies such as chest CT (assuming CXR
does not show anything) bornchoscopy, TB skin test, immunologic studies.
etc.
In the case presented here recently, looking for laryngeal cleft is a fine
idea but tracheo- or broncho- esophageal fistula will also need to be
considered, in addition to localized bronchiectasis.
In theory, one could do a lipid-laden macrophage index on secretions
obtained at bronchoscopy and if elevated it is considered hard evidence of
aspiration. In practice it is rarely used and may not be as clear-cut as
once thought anyways.
Vikki Stefans, M.D., pediatric physiatrist (rehab doc for kids) at UAMS
and Arkansas Children's Hospital. Working Mom of Sarah T. and Michael C.,
and wife of Henry Stefans. Every mom is a working mom!- OK, dads too.
On Fri, 27 Jan 2006, Sarah Ware wrote:
> Thank you for your response. What I'd really like to know is what tests
> doctors may use, even though they aren't efficacious, to say "aspiration
> pneumonia". Sputum culture? Lung culture? Believe me, I know that
> they throw the term around a lot, but I'm curious about what the current
> standards are.
>
> Thank you,
>
> Sarah
>
>
>
>
>
>> From: Drirenect@aol.com
>> To: skware1@msn.com, dysphagia@b9.com
>> Subject: Re: [Dysphagia] aspiration pneumonia
>> Date: Wed, 25 Jan 2006 21:51:17 EST
>>
>> There is no way to determine this even at autopsy. The literature is
>> replete
>> with articles on the subject.
>> _______________________________________________
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>
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