10 Clinical Minutes: Aspiration Pneumonia

[@linopango3145]

Great video! I have just a question: is there an exam able to distinguish between chemical pneumonitis and aspiration pneumonia? I suppose that it could be a bronchoscopy with biopsy, but sure it is not a "routine" exam. So, there is in front of me a patient with caugh, fever and typical Rx: i give him antibiotics? Even if i don't know the etiology? thank you

[@decodingdx8285]

I think it'd be helpful to take a step back and think about when you would be trying to distinguish chemical pneumonitis from pneumonia. Usually this is in the situation of an opacity on a chest x-ray of patient who you either know or suspect has aspirated but they're *not* overtly having pneumonia symptoms. If it's within 24 hours of the suspected event and the patient *isn't* having pneumonia Sx, then it's reasonable to observe the clinical course without antibiotics because it very well could be pneumonitis. However if your patient has an opacity on CXR PLUS a fever, cough, other Sx of pneumonia... then that's the diagnostic criteria for pneumonia! (And of course, you should treat appropriately)

[@linopango3145]

Therefore the differential diagnosis in the clinical setting is based on the type of clinical course (acute or chronic?), on the type of symptoms (type of sputum, presence of cough..) and on the anamnesis? Is it fair to say that coughing is not a symptom of respiratory distress syndrome associated with chemical pneumonitis (but we can find it in the insidious aspiration pneumonia)? is fever instead present in both chemical and aspiration pneumonia? thanks for the answer, your job is great

[@decodingdx8285]

@@linopango3145 Sorry for the delay - I'm a resident and thus can't always reply immediately. But in general, yes the order of your differential really depends on the clinical context. This really comes into play when you have a confirmed or suspected aspiration event then find an opacity on CXR. If it's within a day or so and the patient doesn't clinically appear to have overt pneumonia, then it's very reasonable to observe and see if they do well off of antibiotics. However, if they appear septic, have a productive cough, etc then it would likely be appropriate to treat for pneumonia. It's possible to have fever in the presence of chemical pnuemonitis (which could be an inflammatory response or could be due to another source!). A fever alone shouldn't necessarily be a decision-maker. It's always important to take the whole clinical picture together to make the best decisions for our patients.

[@linopango3145]

@@decodingdx8285 absolutely no problem with the delay, thank you very much. I wish I had teachers like you. good job! I wish you the best