الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 141 |  |  |
| | | from | 141 | | |
Abstract
Pulmonary aspiration is the pathologic passage of fluid or substances below the level of the vocal cords into the lower airways. The clinical manifestation of an aspiration event falls within a wide spectrum ranging from subclinical manifestations, such as dry cough or dysphonia to a fulminant life-threatening condition, such as the acute respiratory distress syndrome (ARDS). The pathogenic process can be further complicated by superimposed secondary infection, lung abscess, airway obstruction, exogenous lipoid pneumonia and progression into chronic interstitial fibrosis. The aim of this study was to assess the efficacy of BAL analysis in differentiation between gastric aspiration pneumonitis and aspiration pneumonia. This study was a prospective case control study carried out on patients with suspected aspiration pneumonia or pneumonitis admitted to Chest Medicine Department, Mansoura University from August 2017 till July 2019. Twenty (20). patients, 12 males and eight females, their age ranged from 20 to 85 years with a mean age of 60.25 ± 16.51 years completed the study. Control group included ten (10) patients, 7 males and three females, their age ranged from 27 to 78 years with a mean age of 57.3 ± 15.96 years completed the study. The most common CT finding among patients under the study was diffuse infiltration in 35%, meanwhile lower lobe infiltration was the most common among control group (30%). As regard the onset of aspiration, 80% of the studied patients presented after more than 48 hours from the last witnessed aspiration event. Patients of control group had higher serum markers of CRP and PCT more than patients of study group, meanwhile among studied cases patients diagnosed as aspiration pneumonia had higher level of CRP and PCT than pneumonitis. BAL pH was significantly lower among cases than control group, which was also lower among cases of aspiration pneumonitis than aspiration pneumonia. As regard frequency of cases with positive lipid laden alveolar macrophage in the bronchoalveolar lavage, group (A) showed highly significant increase more than that found in group (B), LLAM was much higher among group of aspiration pneumonitis than aspiration pneumonia. The frequency of BAL positive cases of starch granules which was found in (35%) of patients in group A which was significantly higher than group B which had no cases with positive BAL starch granules. Cultures of BAL of group A were positive in 45% of cases and 80% of cases in group B which did not have any significant difference. Both group A and B, gram +ve cocci was the most frequent organism among positive cases, followed by both gram -ve bacilli and mixed infection. Conclusion: Aspiration syndrome is a frequent problem, which particularly affects a vulnerable population and is often missed or misdiagnosed. Depending on multiple markers in serum as CRP and PCT or BAL as LLAM, starch granules and culture facilitate and guide good differentiation between both aspiration pneumonia and pneumonitis.