Aspiration pneumonia natural history, complications, and prognosis
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chemical pneumonitisEditor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Aspiration pneumonia occurs following aspiration of different materials and particles. Natural history, complications, and prognosis are different for each category. Chemical pneumonitis usually develop after aspiration of gastric acid and might present acutely within two hours. Rapid clinical recovery or worsening of respiratory distress and hypoxemia might happen. Bacterial infection following aspiration is slower that other community-acquired pneumonia and might be acute, subacute, or chronic. Foreign body aspiration might present acutely with mechanical obstruction or chemical pneumonitis. Patients might present acutely with inflammation and cough, fever, and dyspnea. However, they might be asymptomatic and present with an incidental mass on radiographs. Complications of aspiration pneumonia include segmental or lobar pneumonia, bronchopneumonia, bronchiectasis, lung abscess, empyema, respiratory failure, bacteremia, and shock.
Natural History, Complications, and Prognosis
Natural History
Chemical pneumonitis
- The symptoms of chemical pneumonitis usually develop after aspiration of gastric acid.
- Following aspiration, within two hours, respiratory distress and cyanosis happen.
- The clinical course following chemical pneumonitis might be rapid clinical recovery or worsening of respiratory distress and hypoxemia.
- Pulmonary fibrosis might happen even after recovery.
Bacterial infection
- Bacterial infection following aspiration is slower that other community-acquired pneumonia.
- Cough, fever, purulent sputum, and dyspnea are typical symptoms of aspiration pneumonia.
- Anaerobic infections might last several days or weeks and patients might present with anemia and weight loss.
- Patients might present later with following complications including lung abscess, necrotizing pneumonia, or empyema.
Foreign body aspiration
- Foreign body aspiration might present acutely with mechanical obstruction or chemical pneumonitis.
- Foreign body aspiration is more common in children from one to three years of age.
- It might be visualized on chest radiographs.
- The Heimlich maneuver is recommended.
Lipoid Pneumonia
- Lipoid pneumonia might happen following aspiration of oil.
- Patients might present acutely with inflammation and cough, fever, and dyspnea. However, they might be asymptomatic and present with an incidental mass on radiographs.
Complications
- Complications of aspiration pneumonia include:
- Segmental or lobar pneumonia
- Bronchopneumonia
- Bronchiectasis
- Lung abscess
- Empyema
- Respiratory failure
- Bacteremia
- Shock
- Death
Prognosis
- Aspiration pneumonia prognosis is generally good, and the 1/5/10-year mortality/survival rate of patients with aspiration pneumonia is approximately [#]%.
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- [Subtype of disease/malignancy] is associated with the most favorable prognosis.
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