Pneumonia, Aspiration

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Etiology/Pathophysiology:
May result from aspiration of formula or gastric contents secondary to gastroesophageal reflux, tracheoesophageal malformations or pharyngoesophageal incoordination. The aspiration usually occurs when the patient is supine during or immediately after feeding. In the supine position the right upper lobe is the most dependent part of the lung and is most frequently affected, with the right middle and lower lobes being less frequently involved. Aspiration on the left side is uncommon. The alveoli and airways are flooded with aspirated material leading to airway obstruction with lobar or segmental atelectasis upon which chemical pneumonitis and superimposed infection may occur. If aspiration is persistent, fibrosis and bronchiectasis may result.

Pathology:
Alveoli and airways are filled with aspirated material.

Imaging Findings:
Infiltrates are seen usually in the right upper lobe, and less often in the right middle and lower lobes. In chronic aspiration, fibrosis and or bronchiectasis may be seen.

DDX:

• Bacterial pneumonia

References:
See References Chapter.

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