Diffuse bronchiolar disease due to chronic occult aspiration

OBJECTIVE: To describe clinical, radiological, and histopathologic features of diffuse bronchiolar disease due to chronic occult aspiration. We provide a case report and a summary of the clinical, radiological, and histopathologic findings in 4 patients with what is likely an underrecognized form of aspiration. PATIENTS AND METHODS: We identified 4 patients encountered from July 2001 to January 2004 who had persistent respiratory symptoms and lung infiltrates and who were eventually diagnosed by surgical lung biopsy as having diffuse bronchiolar disease due to chronic occult aspiration. Medical records, radiological studies, and histopathologic specimens were reviewed to assess their clinicoradiologic presentation and diagnostic features. RESULTS: The mean age of these 4 patients was 50 years (age range, 41-59 years), and 2 were women. All presented with persistent dyspnea, cough, and lung infiltrates. Three had a history of gastroesophageal reflux, but only I had active symptoms. Chest radiography showed interstitial Infiltrates, whereas the predominant finding on computed tomography was numerous centrilobular nodules in all patients. Bronchoscopic lung biopsies had been performed in all patients, and the results were nondiagnostic. Surgical lung biopsy specimens revealed diagnostic features that consisted of bronchiolocentric organizing pneumonia with giant cells that contained material consistent with food in all 4 patients. CONCLUSION: Diffuse bronchiolar disease likely represents an underrecognized form of aspiration-related lung disease and may occur in relatively young Individuals without symptoms suggestive of recurrent aspiration. Radiological features associated with this disorder are distinctively different from those seen in aspiration pneumonia.