Diffuse aspiration bronchiolitis (DAB) represents a clinical entity characterized by chronic bronchiolar inflammation resulting from recurrent aspiration of food particles. Autopsy studies suggest that DAB occurs mainly in elderly, debilitated patients that are known to have dysphagia and at risk for aspiration. We reviewed four cases of evaluated at our institution in an attempt to further characterize the clinical, radiologic, and histopathologic aspects of this condition.
Patients with DAB evaluated at The Mayo Clinic, Rochester, MN were identified using a computer assisted search. Medical records, radiologic studies, and histopathologic specimens were reviewed to assess clinical presentation, laboratory and pulmonary function results, radiologic findings, and histopathologic features.
We identified four patients with DAB (2 men/2 women; average age: 50 years [range 41 to 59 years]). Three were current or former smokers. All four had dyspnea and cough. Three patients had experienced recurrent pneumonia. All patients had a prior history of gastroesophageal reflux (GERD) or peptic ulcer disease. Chest radiographs demonstrated interstitial infiltrates and “slight fibrosis”. Chest computed tomography (CT) demonstrated diffuse centrilobular nodularity in all patients; two patients also had bronchiectasis. All had lung biopsies that demonstrated histopathologic findings of diffuse bronchiolar disease due to aspiration. No patient had a history of aspiration or regurgitation. One patient had a history of any neurologic disorder (nonspecific neuromuscular weakness). Subsequent evaluation included esophagogastroduodenoscopy (EGD) in 3 patients (all had esophagitis), video swallow in 2 (both normal), and upper GI series in 2 (both demonstrated esophageal reflux).
DAB likely represents an underrecognized form of diffuse bronchiolar disease. In contrast to previous reports, our patients were relatively young, not debilitated, and only one had a neurologic disorder. There were no symptoms suggestive of regurgitation or aspiration. These findings demonstrate that DAB can occur in patients without clinical symptoms of aspiration.
DAB should be considered in a patient with radiographic signs of bronchiolar disease, particularly for those with a history of GERD or recurrent pneumonia, even when symptoms of aspiration are absent.
T.W. Barnes, None.