CXR Case 026

There are diffuse increased interstitial markings throughout both lungs without zonal distribution.

The reticular-nodular pattern is consistent with pulmonary fibrosis

*There is an air-fluid level overlapping the heart shadow, with absence of usual gastric air sinus. This is in keeping with a large hiatus hernia*

This patient is at risk of aspiration, and given the context of unlikely infection, this is the most likely reason for the acute presentation.

*She has a background of pulmonary fibrosis which in this case is not caused by aspiration, but is a well recognized complication of pulmonary fibrosis.*

Acute aspiration of gastric contents causes a chemical pnuemonitis and the role of empirical antibiotics is controversial.

Many patients recover quickly over 24-48 hours. Supportive therapy and oxygenation may be required.

Should clinical and radiographic evidence of pneumonia develop, then antibiotics are indicated.

*In the community setting the most frequently isolated organisms are: S. Aureus, S. pneumoniae, Bacteroides sp., Fusobacterium and Prevotella sp.

* In the hospital setting, the spectrum differs: S. aureus, E. coli, Klebsiella sp., Proteus sp. and Pseudomonas aeroginosa.