Aspiration bronchiolitis
Aspiration bronchiolitis, or diffuse aspiration bronchiolitis, is a condition characterized by a chronic inflammation of bronchioles caused by recurrent aspiration of foreign particles.
Epidemiology
Associations
- neurologic disorders: ~ 50%
- dementia: ~50%
Risk factors
Patients with esophageal conditions such as achalasia, Zenker diverticulum, or esophageal carcinoma are at risk for aspiration bronchiolitis.
Clinical presentation
The onset of aspiration bronchiolitis can be more insidious than aspiration pneumonia, and in half of the patients, episodes of aspiration can be unrecognised . Patients may have a chronic cough.
Pathology
It is characterized by a chronic inflammatory reaction to repeatedly aspirated foreign particles in the bronchioles.
Radiographic features
HRCT
Aspiration bronchiolitis may be seen as unilateral or bilateral foci of :
- branching areas of increased attenuation with tree-in-bud change
- centrilobular nodules
- mottled, poorly defined acinar areas of increased attenuation.
Consolidation is not a major radiological finding.
Treatment and prognosis
A chronic cough in aspiration bronchiolitis usually does not respond to β-adrenergic bronchodilators or to inhaled steroids. Swallowing rehabilitation and temporary intravenous alimentation are considered the most effective way to reduce the symptoms .
Differential diagnosis
If features are diffuse consider:
- diffuse panbronchiolitis from another (non-aspiration) cause
As a broader differential on CT, consider other forms of bronchiolitis.
See also
