Aspiration pneumonitis and aspiration pneumonia are clinical syndromes caused by aspiration. These conditions are clinically significant due to their high morbidity and mortality. However, aspiration as a preceding event are often unwitnessed, particularly in cases of asymptomatic or silent aspiration. Furthermore, despite the difference in treatment approaches for managing aspiration pneumonitis and aspiration pneumonia, these two disease entities are often difficult to discriminate from one another, resulting in inappropriate treatment. The use of unclear terminologies hinders the comparability among different studies, making it difficult to produce evidence-based conclusions and practical guidelines. We reviewed the most recent studies to define aspiration, aspiration pneumonitis, and aspiration pneumonia, and to further assess these conditions in terms of incidence and epidemiology, pathophysiology, risk factors, diagnosis, management and treatment, and prevention.
Diagnosis ; Epidemiology ; Incidence ; Mortality ; Pneumonia* ; Pneumonia, Aspiration ; Risk Factors

Odontogenic infections are a normally locally confined, self-limiting process that is easily treated by antibiotic therapy and local surgical treatment. However, it may spread into the surrounding tissues through a perforation of the bone, and into contiguous fascial spaces or planes like the primary or secondary fascial spaces. If the infection extends widely, it may spread into the lateral pharyngeal and retropharyngeal space. The retropharyngeal space is located posterior to the pharynx. If an odontogenic infection spreads into this space, severe life-threatening complications will occur, such as airway obstruction, mediastinitis, pericarditis, pleurisy, pulmonary abscess, aspiration pneumonia and hematogenous dissemination to the distant organs. The mortality rate of mediastinitis ranges from 35% to 50%. Therefore, a rapid evaluation and treatment are essential for treating retropharyngeal space abscesses and preventing severe complications. Recently, we encountered two cases of a retropharyngeal space abscess due to the spread of an odontogenic infection. In all patients, early diagnosis was performed by computed tomography scanning and a physical examination. All patients were treated successfully by extensive surgical and antibiotic therapy.
Abscess ; Airway Obstruction ; Early Diagnosis ; Humans ; Lung Abscess ; Mediastinitis ; Pericarditis ; Pharynx ; Physical Examination ; Pleurisy ; Pneumonia, Aspiration

Cricopharyngeal incoordination of infancy is a rare disease, characterized by difficult swallowing soon after birth. regurgitation, frequent choking and aspiration with deglutition, recurrent aspiration pneumonia, and to-and-fro movement of the contrast medium in the posterior pharynx on upper esophageal cineroentgenography. Clinical investigation was performed in the infants who were admitted due to difficult swallowing, regurgitation, and recurrent pneumonia from March 1, 1989 to June 30, 1992. The results were as follows: 1) Male to female sex ratio was great, and major symptoms such as difficult swallowing, regurgitation, choking and aspiration with deglutition, and those of pneumonia developed soon after birth in most cases. 2) The typical findings of this disease were noted on the cineroentgenography of upper esophagus in all cases and those of aspiration pneumonia in 10 cases. 3) The infants had been fed via gavage tube until they were able to swallow without difficulties before and after 6 months after birth. 4) Cricopharyngeal incoordination is a rare disease, but we suggest this disease should be considered in differential diagnosis in the infants with difficult swallowing soon after birth and recurrent episodes of aspiration pneumonia.
Airway Obstruction ; Ataxia* ; Deglutition ; Diagnosis, Differential ; Esophagus ; Female ; Humans ; Infant ; Male ; Parturition ; Pharynx ; Pneumonia ; Pneumonia, Aspiration ; Rare Diseases ; Sex Ratio

As upper-gastrointestinal endoscopy has been more widely used for the diagnosis and treatment of upper gastrointestinal diseases, some complications such as bleeding, perforation, arrhythmia, aspiration pneumonia, infection, and drug reaction of premedication were reported. Also a few case of salivary gland swelling complicated by endoscopy was described, but the precise mechanism of this benign complication is not well-known. The hypothesized mechanisms for salivary gland swelling are 1) air distension of blind branchial cleft remmants, 2) compression of its duct between the mylohyoid and hyoglossus muscles from pressure above, during a time of increased salivary flow from oral stimulation, 3) forward and downward dislocation of gland by the force that occurs when endoscope pushes the tongue, and 4) reaction to topical anesthesia less likely. Here we report 5 cases of salivary galnd swelling with a review of the literature, explaining possible mechanism of each case.
Anesthesia ; Arrhythmias, Cardiac ; Branchial Region ; Diagnosis ; Dislocations ; Endoscopes ; Endoscopy* ; Gastrointestinal Diseases ; Hemorrhage ; Muscles ; Pneumonia, Aspiration ; Premedication ; Salivary Glands* ; Tongue

Dysphagia is difficulty of effect movement of the bolus from the mouth to the stomach. From and anatomical standpoints, dysphagia is typically classified as oropharyngeal dysphagia (OPD) and esophageal dysphagia (ED). In general, OPD is more highly prevalent condition compared with ED, and associated with severe complications such as malnutrition, dehydration and aspiration pneumonia. These complications are fatal especially in the elderly. Therefore, for preventing severe complications, appropriate and prompt management should be provided to dysphagia patients. However, the decrease of swallowing function is considered as a part of natural aging process. This condition is called as presbyphagia. Although Presbyphagia refers to characteristic changes in the process of swallowing of healthy elderly, it can be a risk factor of dysphagia. With this in mind, for avoiding overdiagnosis or underdiagnosis of dysphagia, we should distinguish among presbyphagia, dysphagia and other related diagnoses. For this reason, understanding about physiology of normal swallowing and natural changes of swallows by aging are essential for physicians. Hence, this review discusses the normal swallow, senile changes of swallow, and dysphagia especially in OPD.
Aged* ; Aging ; Deglutition ; Deglutition Disorders* ; Dehydration ; Diagnosis ; Humans ; Malnutrition ; Medical Overuse ; Mouth ; Physiology ; Pneumonia, Aspiration ; Risk Factors ; Stomach ; Swallows

Exogenous lipoid pneumonia is an uncommon medical condition resulting from aspiration or inhalation of oily material. Generally, lipoid pneumonia has nonspecific clinical and radiological presentations, and may be misdiagnosed as bacterial pneumonia or lung cancer. We describe an unusual case of exogenous lipoid pneumonia accompanied by peripheral blood and pulmonary eosinophilia. A 63-year-old man was admitted with progressively worsening exertional dyspnea and productive cough for 5 days. A chest radiograph showed abnormalities in the lower lobe of the right lung, and a diagnosis of community-acquired pneumonia was made; intravenous antibiotics were administered. However, dyspnea and hypoxia gradually worsened and peripheral blood eosinophilia developed. A bronchoscopy was performed and bronchoalveolar lavage fluid analysis showed markedly increased numbers of eosinophils (40%). Subsequently, a comprehensive review of history revealed that he fell asleep with camellia oil in his mouth for 2 weeks to relieve foreign body sensation of the throat. Sputum and bronchoalveolar lavage fluid cytology showed the presence of lipid-laden macrophages. He was diagnosed with lipoid pneumonia and acute eosinophilic pneumonia. Chest radiograph and symptom were rapidly improved after treatment with intravenous methylprednisolone.
Anoxia ; Anti-Bacterial Agents ; Bronchoalveolar Lavage Fluid ; Bronchoscopy ; Camellia ; Cough ; Diagnosis ; Dyspnea ; Eosinophilia ; Eosinophils* ; Foreign Bodies ; Humans ; Inhalation ; Lung ; Lung Neoplasms ; Macrophages ; Methylprednisolone ; Middle Aged ; Mouth ; Pharynx ; Pneumonia* ; Pneumonia, Bacterial ; Pneumonia, Lipid ; Pulmonary Eosinophilia* ; Radiography, Thoracic ; Respiratory Aspiration ; Sensation ; Sputum

PURPOSE: The development of postnatal pneumothorax and its common causes and clinical aspects were studied to promote early diagnosis and proper management. METHODS: A retrospective study of neonates who were hospitalized in the neonatal intensive care unit at Soonchunhyang University Bucheon Hospital from 2001 to 2010 was performed. Term neonates were divided into a spontaneous pneumothorax group and a secondary pneumothorax group. The secondary group was divided into term and preterm groups. RESULTS: Of 4,414 inpatients, 57 (1.3%) were diagnosed with pneumothorax. Of term newborn patients, 28 (80%) had a secondary pneumothorax, and seven (20%) had a spontaneous pneumothorax. No differences were observed for gender, birth weight, resuscitation, or duration of admission between the spontaneous and control groups. The duration of treatment with a thoracostomy (20 patients, 57%) was longer in the spontaneous group (5.4+/-2.9 days vs. 2.7+/-2.0 days) than that in the control group. Patients with respiratory distress syndrome (RDS) developed a pneumothorax 22.8 hours after surfactant treatment, whereas patients with transient tachypnea of the newborn (TTN), pneumonia, and meconium aspiration syndrome (MAS) developed pneumothorax after 16.6 hours. Of 50 patients with a secondary pneumothorax, 19 (38%) had RDS, 11 (22%) had MAS, 7 (14%) had TTN, and six (12%) had pneumonia. Among term newborns, 42.9% were treated only with 100% oxygen. Among preterm newborns, 72.6% and 27.3% needed a thoracostomy or ventilator care, respectively. CONCLUSION: A pneumothorax is likely to develop when pulmonary disease occurs in neonates. Therefore, it is important to carefully identify pneumothorax and provide appropriate treatment.
Birth Weight ; Early Diagnosis ; Humans ; Infant, Newborn ; Inpatients ; Intensive Care, Neonatal ; Lung Diseases ; Meconium Aspiration Syndrome ; Oxygen ; Pneumonia ; Pneumothorax ; Resuscitation ; Retrospective Studies ; Thoracostomy ; Transient Tachypnea of the Newborn ; Ventilators, Mechanical

OBJECTIVE: To identify the associations between the duration of endotracheal intubation and developing post-extubational supraglottic and infraglottic aspiration (PEA) and subsequent aspiration pneumonia. METHODS: This was a retrospective observational study from January 2009 to November 2014 of all adult patients who had non-neurologic critical illness, required endotracheal intubation and were referred for videofluoroscopic swallowing study. Demographic information, intensive care unit (ICU) admission diagnosis, severity of critical illness, duration of endotracheal intubation, length of stay in ICU, presence of PEA and severity of dysphagia were reviewed. RESULTS: Seventy-four patients were enrolled and their PEA frequency was 59%. Patients with PEA had significantly longer endotracheal intubation durations than did those without (median [interquartile range]: 15 [9-21] vs. 10 [6-15] days; p=0.02). In multivariate logistic regression analysis, the endotracheal intubation duration was significantly associated with PEA (odds ratio, 1.09; 95% confidence interval [CI], 1.01-1.18; p=0.04). Spearman correlation analysis of intubation duration and dysphagia severity showed a positive linear association (r=0.282, p=0.02). The areas under the receiver operating characteristic curves (AUCs) of endotracheal intubation duration for developing PEA and aspiration pneumonia were 0.665 (95% CI, 0.542-0.788; p=0.02) and 0.727 (95% CI, 0.614-0.840; p=0.001), respectively. CONCLUSION: In non-neurologic critically ill patients, the duration of endotracheal intubation was independently associated with PEA development. Additionally, the duration was positively correlated with dysphagia severity and may be helpful for identifying patients who require a swallowing evaluation after extubation.
Adult ; Critical Illness* ; Deglutition ; Deglutition Disorders* ; Diagnosis ; Fluoroscopy ; Humans ; Intensive Care Units ; Intubation* ; Intubation, Intratracheal ; Length of Stay ; Logistic Models ; Observational Study ; Peas ; Pneumonia, Aspiration* ; Retrospective Studies ; ROC Curve

PURPOSE: This study was performed to test the clinical usefulness of the glucose test strip method for early detection of pulmonary aspiration in tube fed patients. METHOD: The subjects for the study were 36 patients who were receiving enteral feedings and 39 patients who were not given enteral feedings. For the analysis, the tube fed patients were divided into two groups (clinically significant aspiration and no aspiration) according to criteria. RESULT: The mean glucose concentration of tracheal secretions from non enteral fed patients was 26.35mg/dl and were lower than those concentrations found in tube fed patients (32.75mg/dl). The mean glucose concentration of the aspiration group was 45.60mg/dl and the glucose concentration of the non aspiration group was 19.93mg/dl. The difference was statistically significant (t=2.163, p=. 038). More subjects in the no aspiration group (73%) than the aspiration group (56%) had glucose concentrations below 20mg/dl. After deleting the cases that had samples containing blood, glucose concentrations of tracheal aspirates were lower in both groups. CONCLUSION: The glucose level of the aspiration group was significantly lower than the no aspiration group and more subjects in the aspiration group had a glucose level higher than 101mg/dl. Therefore, the glucose test of tracheal secretions in tube fed patients could be a desirable test for screening for tracheal aspiration. Especially the patient who is showing repeatedly high glucose levels should not be given feedings until reassessment is completed.
Adult ; Aged ; Aged, 80 and over ; Enteral Nutrition/*adverse effects ; Female ; Glucose/*analysis ; Humans ; Intubation, Gastrointestinal/*adverse effects ; Male ; Middle Aged ; Pneumonia, Aspiration/*diagnosis ; *Reagent Strips ; Trachea/*secretion

OBJECTIVE: The objective is to clarify the long-term functional outcome of NF-2 and to elucidate optimal treatment strategy. METHODS: The authors retrospectively analyzed clinical records and radiological imaging of 32 patients of NF-2 treated at from 1979 to 2000. Age at diagnosis was 30(14-54). Male to female ratio was 14:18. Mean follow-up(F/U) periods were 61(6-240) months. Four patients were lost during F/U periods. Fifty-one tumors of 29 patients were surgically treated including radiosurgery, and three patients rejected any treatment. Eleven tumors of 10 patients with non-schwannomas were managed by craniotomy, and one of them was managed by biopsy only. Among 21 tumors of 19 patients with schwannomas, 16 tumors of 14 patients were vestibular schwannomas(VS), one trigeminal schwannoma, and four spinal schwannomas. Fourteen tumors with 13 patients were managed by radiosurgery. RESULTS: Presenting symptoms were hearing problem(44%, 14/32 patients), motor or sensory change (25%, 8/32 patients), and visual symptoms (15%, 5/32 patients). Long-term functional outcome was poor (KPS; median 46.6). Six patients died during follow periods and the cause of death was aspiration pneumonia related to lower cranial palsy or high cervical cord lesion(except 1 case; suicide). In 17 patients, 7 patients of initial hearing had preserved after any treatment modalities, another 10 patients had deteriorated hearing function. In facial nerve function, 12 patients except one patient deteriorated after surgical resection. Even though facial-hypoglossal anastomosis was performed in two patients, there was no improvement of facial nerve function. CONCLUSION: Long-term results of NF-2 patients were unfavorable. The early detection of the tumor, regular F/U of patients and individually refined management are important for the optimal treatment of NF-2 patients.
Biopsy ; Cause of Death ; Craniotomy ; Diagnosis ; Facial Nerve ; Female ; Hearing ; Humans ; Male ; Neurilemmoma ; Neurofibromatoses* ; Neurofibromatosis 2* ; Paralysis ; Pneumonia, Aspiration ; Radiosurgery ; Retrospective Studies ; Treatment Outcome*