MDCT Evaluation of Foreign Bodies and Liquid Aspiration Pneumonia in Adults
Miyoung Kim1,
Ki Yeol Lee1,
Kyung Won Lee2 and
Kyongtae T. Bae3
1 Department of Diagnostic Radiology, University of Korea Ansan Hospital, Seoul,
Korea.
2 Department of Diagnostic Radiology, University of Bundang Seoul National
University Hospital, Seoul, Korea.
3 Department of Radiology, University of Pittsburgh, 3362 Fifth Ave.,
Pittsburgh, PA 15232.
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Fig. 1 —Aspiration of bread piece in trachea of 34-year-old man with
mental retardation and abrupt dyspnea. Chest CT image (5-mm collimation, lung
window setting) after bronchoscopic removal of bread shows subcutaneous
emphysema, pneumomediastinum, and upper lung predominant consolidation in
bilateral dependent lungs. Consolidation represents additional areas of
aspiration that probably preceded tracheal aspiration.
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Fig. 2A —Aspiration of shrimp to left main bronchus during bedside
feeding in 71-year-old man with history of Parkinson's disease and abrupt
dyspnea. Contrast-enhanced CT image (mediastinal window setting) shows
endobronchial spongy soft-tissue material in left main bronchus
(arrow) and completely collapsed left lung.
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Fig. 2B —Aspiration of shrimp to left main bronchus during bedside
feeding in 71-year-old man with history of Parkinson's disease and abrupt
dyspnea. Photograph shows shrimp retrieved by bronchoscopy.
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Fig. 3A —Aspiration of tooth to right main bronchus in 43-year-old man
with dyspnea and fever. Contrast-enhanced CT images show tooth aspirated to
right main bronchus and associated atelectasis of right mid and lower
lobes.
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Fig. 3B —Aspiration of tooth to right main bronchus in 43-year-old man
with dyspnea and fever. Contrast-enhanced CT images show tooth aspirated to
right main bronchus and associated atelectasis of right mid and lower
lobes.
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Fig. 3D —Aspiration of tooth to right main bronchus in 43-year-old man
with dyspnea and fever. Oblique coronal multiplanar reformatted image shows
exact location of aspirated tooth in reference to main bronchus.
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Fig. 4A —Aspiration of clam shell to right main bronchus in
62-year-old man with blood-tinged sputum. Contrast-enhanced CT image shows
curvilinear calcific attenuation in dependent portion of right main bronchus
(arrow). No associated lung abnormality is seen. Incidental calcified
pleural plaque is present in right posteromedial thorax. Chest radiograph (not
shown) was normal.
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Fig. 5A —Aspiration of piece of wood to left lower lobar bronchus in
16-year-old boy with persistent fever after motor vehicle accident.
High-resolution CT image (2-mm collimation, lung window setting) shows large
consolidation in left lower lobe and rounded opacity in cross section
surrounded by crescent of air (arrow) in truncus basalis to basilar
segments of left lower lobe.
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Fig. 6A —Aspiration of toothpick to left lateral basal segmental
bronchus in 19-year-old man with no symptoms. Axial chest CT images (5-mm
collimation, lung [A] and mediastinal [B] window settings) show
focal bronchiectasis (arrow, A) proximal to toothpick
(arrow, B) in lateral basal segmental bronchus of left lower
lobe. Chest radiograph (not shown) was normal.
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Fig. 6B —Aspiration of toothpick to left lateral basal segmental
bronchus in 19-year-old man with no symptoms. Axial chest CT images (5-mm
collimation, lung [A] and mediastinal [B] window settings) show
focal bronchiectasis (arrow, A) proximal to toothpick
(arrow, B) in lateral basal segmental bronchus of left lower
lobe. Chest radiograph (not shown) was normal.
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Fig. 6C —Aspiration of toothpick to left lateral basal segmental
bronchus in 19-year-old man with no symptoms. Coronal reformatted CT image
(mediastinal window setting) shows linear endobronchial lesion
(arrow) in lateral basal segmental bronchus of left lower lobe.
Bronchoscopic evaluation confirmed segmental bronchiectasis, and wooden
material with mucus impaction was retrieved.
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Fig. 7A —Aspiration of gastric acid to bilateral dependent lungs in
60-year-old man with fever and loss of consciousness. Chest CT images (2-mm
collimation, lung window setting) show extensive bilateral airspace
consolidation, mainly in dependent portions of lungs.
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Fig. 7B —Aspiration of gastric acid to bilateral dependent lungs in
60-year-old man with fever and loss of consciousness. Chest CT images (2-mm
collimation, lung window setting) show extensive bilateral airspace
consolidation, mainly in dependent portions of lungs.
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Fig. 8A —Near-drowning in fresh water in 34-year-old woman with
history of schizophrenia and dyspnea. High-resolution CT image (2-mm
collimation) obtained 2 days after incident shows consolidation in posterior
upper lobes. Surrounding ground-glass opacity likely reflects exudative stage
of adult respiratory distress syndrome.
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Fig. 8B —Near-drowning in fresh water in 34-year-old woman with
history of schizophrenia and dyspnea. Follow-up high-resolution chest CT image
(2-mm collimation) 9 days later shows development of volume contractile
consolidation, probably representing proliferative stage of adult respiratory
distress syndrome.
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Fig. 9A —Chronic exogenous lipoid pneumonia in 50-year-old man with
history of taking fish oil (squalene) tablets for 6 months and multiple
episodes of aspiration but no symptoms. High-resolution CT images (2-mm
collimation, lung window setting) show geographic ground-glass opacity with
superimposed intra- and interlobular septal thickening in right middle
lobe—that is, characteristic crazy-paving pattern and lobular
consolidation. Faint mild alveolar infiltrates are also present in right lower
lobe.
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Fig. 9B —Chronic exogenous lipoid pneumonia in 50-year-old man with
history of taking fish oil (squalene) tablets for 6 months and multiple
episodes of aspiration but no symptoms. High-resolution CT images (2-mm
collimation, lung window setting) show geographic ground-glass opacity with
superimposed intra- and interlobular septal thickening in right middle
lobe—that is, characteristic crazy-paving pattern and lobular
consolidation. Faint mild alveolar infiltrates are also present in right lower
lobe.
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Fig. 10 —Acute exogenous lipoid pneumonia in 23-year-old man with
accidental aspiration of kerosene and chest discomfort. CT image (5-mm
collimation, lung window setting) shows area of well-defined consolidation and
ground-glass opacities in right middle lobe.
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Fig. 11 —Acute exogenous lipoid pneumonia in 38-year-old man with
acute accidental aspiration of paraffin oil and chest discomfort.
Contrast-enhanced CT image shows areas of well-defined consolidation, small
area of fat attenuation (-40 H) (arrow), and air bronchograms in
right middle and left lower lobes.
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Fig. 12 —Aspiration of infectious material from oropharynx to
posterior segment of right upper lobe in 40-year-old man with periodontal
disease, actinomycosis, and low-grade fever. Contrast-enhanced CT image shows
peripheral focal consolidation and internal necrosis, suggesting abscess
formation.
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Fig. 13A —Pyogenic lung abscess from aspiration in 65-year-old woman
with history of achalasia, cough, fever, and sputum. Contrast-enhanced CT
image (mediastinal window setting) shows large solid mass with necrosis in
right upper and lower lobes. Esophagus is dilated and esophageal wall is
mildly thickened.
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Fig. 13B —Pyogenic lung abscess from aspiration in 65-year-old woman
with history of achalasia, cough, fever, and sputum. Esophagography shows
diffusely dilated esophagus with distal beak appearance, consistent with
achalasia. Although bronchogenic carcinoma was suspected clinically, chronic
pyogenic lung abscess was diagnosed at transbronchial biopsy.
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Fig. 14A —Aspiration through bronchoesophageal fistula in 82-year-old
man with history of radiation therapy for esophageal carcinoma, persistent
cough, and sputum. Contrast-enhanced chest CT image shows fistula
(arrow) between esophagus and left main bronchus.
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Fig. 14B —Aspiration through bronchoesophageal fistula in 82-year-old
man with history of radiation therapy for esophageal carcinoma, persistent
cough, and sputum. High-resolution CT image (2-mm collimation) shows multiple
patchy, irregular parenchymal areas of increased attenuation in both
lungs.
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Fig. 15A —Pyogenic lung abscess from aspiration of gastric fluid
through esophagopulmonary fistula in 55-year-old man with fever.
Contrast-enhanced CT image (mediastinal window setting) shows
esophagopulmonary fistula (arrow) and consolidation with necrosis in
right lower lobe.
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Fig. 15B —Pyogenic lung abscess from aspiration of gastric fluid
through esophagopulmonary fistula in 55-year-old man with fever. CT image
(5-mm collimation, lung window setting) shows consolidation and cavitary
abscess in right lower lobe and focal pneumonic infiltrate in left upper
lobe.
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Copyright © 2008 by the American Roentgen Ray Society.
