CTICasesBarium Aspiration in Head and Neck Cancer Patient (Diffuse Aspiration Bronchiolitis)
Imaging findings
A patient with head and neck cancer presented with diffuse tree-in-bud opacities, plugged larger airways, and consolidations predominantly in the dependent lower lobes, right middle lobe, and lingula on initial CT, consistent with aspiration bronchiolitis. A subsequent chest radiograph revealed widespread high-attenuation material within the airways and lung parenchyma, confirming barium aspiration. A more recent CT showed increased bronchiectasis in the lower lobes with persistent plugged airways and small tree-in-bud nodules.
Key takeaways
Head and neck cancer patients, especially those with laryngectomy, are at high risk for aspiration bronchiolitis. Barium aspiration can occur during pre-procedural imaging for percutaneous gastrostomy (PEG) tube placement, manifesting as diffuse high-attenuation material in the lungs. Radiographic findings can dramatically confirm diffuse aspiration, highlighting the importance of cautious contrast administration in at-risk patients.
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