Carta Acesso aberto Revisado por pares

Right Middle Lobe Aspiration Pneumonia following Gasoline Siphonage

1981; Elsevier BV; Volume: 80; Issue: 2 Linguagem: Inglês

10.1378/chest.80.2.246b

ISSN

1931-3543

Autores

David Carlson,

Tópico(s)

Lung Cancer Diagnosis and Treatment

Resumo

To the Editor: Over the past three years we have had three patients present with right middle lobe aspiration pneumonia occurring after attempts to siphon gasoline from motor vehicles. The following report is typical. This 18-year-old woman was admitted with right-sided pleuritic pain and productive cough two days after having inhaled gasoline she was siphoning from a car. She had also swallowed some of the gasoline which she vomited. Her admission temperature was 100.4° F (38.0° C) with fine moist rales heard anteriorly over the right midlung field. PA and lateral chest roentgenograms showed a right middle lobe consolidation without loss of volume (Fig 1). The white blood cell count was 14,000, with 46 polys and 25 bands. The patient was treated with IPPB, analgesics and erythromycin with good response and was discharged three days after admission. While much has been written on aspiration pneumonia1Ribardo AA Grace WJ Pulmonary aspiration..Am J Med. 1971; 50: 510-520Abstract Full Text PDF PubMed Scopus (43) Google Scholar and hydrocarbon pneumonitis2Bonte FJ Reynolds J Hydrocarbon pneumonitis..Radiology. 1958; 71: 391-397Crossref PubMed Scopus (9) Google Scholar, 3Eade NR Taussig LM Marks MI Hydrocarbon pneumonitis..Pediatrics. 1974; 54: 351-357PubMed Google Scholar the specific nature in which the right middle lobe is involved in our cases is considered rather unique. Hydrocarbons elicit very little cough reflex and are therefore easy substances for direct aspiration, either diffusely or into the lower lobes.1Ribardo AA Grace WJ Pulmonary aspiration..Am J Med. 1971; 50: 510-520Abstract Full Text PDF PubMed Scopus (43) Google Scholar, 2Bonte FJ Reynolds J Hydrocarbon pneumonitis..Radiology. 1958; 71: 391-397Crossref PubMed Scopus (9) Google Scholar In order to selectively fill the middle lobe, the patient would have to be bent forward in exactly the position assumed on siphoning gasoline. The only other patient in our files with selective right middle lobe aspiration pneumonia occurred after a suicide attempt with ingestion of paint thinner. In this case, the patient was unconscious and probably vomited and aspirated when lying prone. Aspiration leading to abscess formation in the right middle lobe has been reported, but is rare.3Eade NR Taussig LM Marks MI Hydrocarbon pneumonitis..Pediatrics. 1974; 54: 351-357PubMed Google Scholar One patient with poor dentition aspirated infective material when bent forward carrying sacks of coal. Another patient fell into a harbor when inebriated and assumedly aspirated oily material when swimming prone, to the dock.3Eade NR Taussig LM Marks MI Hydrocarbon pneumonitis..Pediatrics. 1974; 54: 351-357PubMed Google Scholar In summary, the recognition that an isolated right middle lobe aspiration may occur when in the siphonage position will help in making this diagnosis, particularly if the patient chooses to conceal this information.

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