[Diagnosis of aspiration pneumonia complicated by acute purulent destruction in persons having risk factors].
OBJECTIVE: To analyze the causes of development of aspiration pneumonia (AP) complicated by acute purulent pulmonary destruction (APPD) and to optimize approaches to its diagnosis, by examining the clinical picture and features of its development in patients having risk factors. SUBJECTS AND METHODS: 431 patients with purulent pulmonary diseases, including 314 (72.8%) patients with abscessed pneumonia and 117 (27.2%) with lung abscesses. The aspiration mechanism of development of the diseases was established in 96 (22.3%) of the 431 patients. The patients' age ranged from 38 to 73 years. There were 87 males and 9 females. The episodes of massive aspiration of the contents of the stomach [45 (46.9%)], and oropharynx [15 (15.6%] and those of foreign body aspiration [36 (37.5%)] were analyzed. RESULTS: The aspiration mechanism of development of the diseases was established in 96 (22%) of the 431 patients with APPD, which accounted for 22.3%. Alcoholic disease was the underlying background disease in most (89.85%) patients, which permits alcoholism to be considered to be one of the major risk factors of the aspiration syndrome. Aspiration with the gastric food contents from the oral cavity was predominant, which makes it possible to consider dysphagia to be one of the most potent predictors of AP. Foreign body aspiration was established in 36 patients, among them 17 patients were found to have aspiration of fragments of teeth, dental fillings, and dentures. The aspiration mechanism of the disease was supported by history data, as established a documented episode of aspiration, by clinical, X-ray (esophageal and gastric roentgenoscopy and roentgenography) and endoscopic (fibrobronchoscopy, esophagogastroscopy) findings, as well as by the conclusions of an ENT specialist, a dentist, a neurologist, a narcological psychiatrist. The algorithm of the pathogenesis of AP and purulent lung diseases was proposed. CONCLUSION: Chronic alcoholism associated with peptic ulcer, chronic gastritis, and hepatic lesion (hepatitis/cirrhosis) is the most important predictor of AP and APPD. Complex clinical and X-ray examination including fibrobronchoscopy, esophagogastroscopy, 24-hour gastric juice pH-metry, and consultations of particular specialists are indicated to support the fact of aspiration.