Aspiration pneumonia

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Alcoholism is a common predisposing condition for aspiration pneumonia. Aspiration of orogastric material (bacteria, acid, food) can also occur in victims rendered unconscious by drugs directly (narcotics) or indirectly by drug-induced seizures (cocaine). The posterior segments of the upper lobes or superior segments of the left lower lobe are involved when the victim is recumbent during aspiration. The basal lung segments are affected when the victim is upright and the anterior segment of the middle lobe is involved when the victim is prone or inclined forward. Gastric acid can produce bronchiolitis, hemorrhagic edema, and diffuse alveolar damage. Fluid contaminated with Streptococcus pneumoniae or Klebsiella pneumoniae characteristically produce a subpleural pneumonia with hemorrhagic edema.36 Aspiration pneumonia often has a mixture of both aerobic and anaerobic bacteria. Striated muscle and vegetable fibers can be seen microscopically within the bronchioles and alveoli. Necrotizing bacteria may produce lung abscesses. Septic thromboemboli from tricuspid valve endocarditis can also produce multiple lung abscesses and pneumonia in the intravenous drug abuser (Figures 2.3.4 and 2.3.5).

Figure 2.3.4 This sectioned lung has multiple abscess cavities. The victim was a 31-year-old cocaine "skin popper".

Figure 2.3.4 This sectioned lung has multiple abscess cavities. The victim was a 31-year-old cocaine "skin popper".

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