Summary
Definition
History and exam
Key diagnostic factors
- acute or chronic cough
- fever
- dyspnea
- wheezing
- crackles
Other diagnostic factors
- laryngospasm
Risk factors
- decreased level of consciousness (Glasgow coma scale score <9)
- increased severity of illness
- general anesthesia
- age >70 years
- male sex
- head trauma
- cerebrovascular disease
- endotracheal or tracheostomy tube
- dysphagia
- airway difficulties
- barium meal
- gastroesophageal reflux disease
- feeding tubes
- supine position
- delayed gastric emptying
- obesity
- drugs that reduce esophageal sphincter tone
Diagnostic tests
1st tests to order
- chest x-ray
Tests to consider
- chest CT
- bronchoscopy with bronchoalveolar lavage
- CBC
- arterial blood gases
- blood culture
- thoracentesis
Treatment algorithm
pneumonitis due to aspiration of gastric contents
pneumonitis due to aspiration of barium
Contributors
Authors
Augustine Lee, MD
Professor of Medicine
Division of Pulmonary and Critical Care Medicine
Mayo Clinic Florida
Jacksonville
FL
Disclosures
AL declares that he has no competing interests.
Spencer Deleveaux, MBBS
Fellow
Division of Pulmonary and Critical Care Medicine
Mayo Clinic Florida
Jacksonville
FL
Disclosures
SD declares that he has no competing interests.
Acknowledgements
Dr Augustine Lee and Dr Spencer Deleveaux would like to gratefully acknowledge Dr Madison Macht, Dr Kamran Mahmood, Dr Scott Shofer, Dr Septimiu Murgu, and Dr Henri Colt, previous contributors to this topic.
Disclosures
MM, KM, SS, SM, and HC declare they have no competing interests.
Peer reviewers
Andrew Parfitt, MBBS, FFAEM
Clinical Director
Acute Medicine
Associate Medical Director
Consultant Emergency Medicine
Guy's and St Thomas' NHS Foundation Trust
Clinical Lead and Consultant
Accident and Emergency Medicine
St Thomas' Hospital
London
UK
Disclosures
AP declares that he has no competing interests.
Momen M. Wahidi, MD, MBA
Director
Interventional Pulmonology
Division of Pulmonary, Allergy, and Critical Care Medicine
Assistant Professor of Medicine
Duke University Medical Center
Durham
NC
Disclosures
MMW declares that he has no competing interests.
Differentials
- Acute respiratory distress syndrome
- Asthma exacerbation
- Cystic fibrosis with exacerbation
More DifferentialsGuidelines
- ACR appropriateness criteria: dysphagia
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