Clinico-radiologic Features of Lung Disease Associated With Aspiration Identified on Lung Biopsy

Bronchiolitis and Bronchiolar Disorders

“…Granulomatous bronchiolitis is most frequently associated with tuberculosis or infection with nontuberculous mycobacteria, well-formed noncaseating granulomas suggest sarcoidosis, poorly formed non-necrotizing granulomas (especially in association with interstitial lymphocytic infiltrates or organizing pneumonia) suggest HP (►Fig. 3) and foreign body giant cells or foreign material suggests aspiration pneumonia 24 (►Fig. 4).…”

“…Another feature of bronchiolitis obliterans with inflammatory or intraluminal polyps is the presence of small blood vessels. 34 Proliferative bronchiolitis may occur secondary to a wide variety of lung injuries (such as aspiration pneumonia, HP, postobstruction organization, exposure to fumes and toxins, CTD, drug reactions, secondary to bone marrow transplantation or other organ transplantation, reaction to radiation therapy, or chemotherapy) 24,34 and it may also be idiopathic. The distribution of lesions is usually focal and heterogeneous, making the diagnosis difficult.…”

“…Chest radiographs can be normal or a mosaic pattern in the CT scan can be detected. 7 Clinical and radiologic correlation is frequently necessary to determine specific etiology, unless within the biopsy there are histologic features indicating an etiologic factor such as viral inclusions suggestive of viral pneumonia or foreign body giant cells suggestive of aspiration 24 (►Fig. 4).…”

“…Diffuse bronchiolar disease as a result of aspiration is an under-recognized form of aspiration-related lung disease; in fact, correctly diagnosing bronchiolitis due to chronic aspiration can be difficult given the nonspecific and varied nature of clinical and radiological abnormalities attributable to this etiology. Risk factors for aspiration may include: altered consciousness (due to organic pathology or medication), dysphagia, vomiting, gastroesophageal reflux disease (GERD), or structural abnormalities involving the upper gastrointestinal tract 24 ; however, it may occur in relatively young individuals without symptoms that are suggestive of recurrent aspirations.…”

“…Recently, Ryu et al analyzed 52 patients with lung disease associated with aspiration identified on lung biopsy 24 ; CT scan revealed bronchiolitis (centrilobular micronodules and tree-in-bud opacities) in 42% patients (►Fig. 12).…”