Chronic occult aspiration can result in a diffuse bronchiolar disease that can be difficult to diagnose. In many patients with aspiration the diagnosis will be straightforward but for these patients the diagnosis may not be immediately obvious.


Clinical features:

(1) The patient presents with persistent respiratory symptoms (cough, dyspnea) with or without a history of unexplained recurrent pneumonia.

(2) Chest X-rays show persistent interstitial infiltrates.

(3) High resolution CT scans show numerous small centrilobular nodules.

(4) An endobronchial biopsy often shows nonspecific findings.

(5) No obvious cause for interstitial lung disease (smoking, occupational, hypersensitivity, etc).

(6) There may be a current or past history of gastroesophageal reflux disease (GERD).


The diagnosis usually requires a surgical wedge biopsy of the lung which shows:

(1) bronchiolocentric organizing pneumonia

(2) multinucleated foreign-body type giant cells

(3) food debris


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