An uncommon etiological factor for aspiration pneumonitis caused by spontaneous sphenoid sinus meningoencephalocele with cerebrospinal fluid rhinorrhea: a case report

Abstract

Background Aspiration pneumonitis is an inflammatory disease of the lungs which is difficult to diagnose accurately. Large-volume aspiration of oropharyngeal or gastric contents is essential for the development of aspiration pneumonitis. The role of cerebrospinal fluid (CSF) rhinorrhea is often underestimated as a rare etiological factor for aspiration in the diagnosis process of aspiration pneumonitis. Case presentation We present a case of a patient with 4 weeks of right-sided watery rhinorrhea accompanied by intermittent postnasal drip and dry cough as the main symptoms. Combined with clinical symptoms, imaging examination of the sinuses, and laboratory examination of nasal secretions, she was initially diagnosed as spontaneous sphenoid sinus meningoencephalocele with CSF rhinorrhea, and intraoperative endoscopic findings and postoperative pathology also confirmed this diagnosis. Her chest computed tomography showed multiple flocculent ground glass density shadows in both lungs on admission. The patient underwent endoscopic resection of meningoencephalocele and repair of skull base defect after she was ruled out of viral pneumonitis. Symptoms of rhinorrhea and dry cough disappeared, and pneumonitis was improved 1 week after surgery and cured 2 months after surgery. Persistent CSF rhinorrhea caused by spontaneous sphenoid sinus meningoencephalocele was eventually found to be a major etiology for aspiration pneumonitis although the absence of typical symptoms and well-defined risk factors for aspiration, such as dysphagia, impaired cough reflex and reflux diseases. Conclusions We report a rare case of aspiration pneumonitis caused by spontaneous sphenoid sinus meningoencephalocele with CSF rhinorrhea, which can bring more attention and understanding to the uncommon etiology for aspiration, so as to make more accurate diagnosis of the disease and early surgical treatment.

Increased prevalence of aspiration pneumonitis in spontaneous cerebrospinal fluid leaks

“…Although antibiotics are indicated in cases of infection, the definitive treatment is the management of CSF fistula 3 . Pronounced emphasis on the perioperative control of pneumonitis may result in unnecessary interventions and treatment delays 6 . For some complex CSF leaks, prolonged surgical duration and postoperative bed rest may aggravate the severity of pneumonitis.…”

“…3 Pronounced emphasis on the perioperative control of pneumonitis may result in unnecessary interventions and treatment delays. 6 For some complex CSF leaks, prolonged surgical duration and postoperative bed rest may aggravate the severity of pneumonitis. It is therefore crucial to provide appropriate care to mitigate the risk of perioperative complications, including aggravation and progression of pneumonia.…”