CTICasesDrowned Lung with Bronchial Casts from Massive Aspiration
Imaging findings
A patient with multiple sclerosis and impaired swallowing has baseline basal atelectasis, then presents with a near-complete left hemithorax whiteout with the trachea dragged left but only modest mediastinal shift and air bronchograms, suggesting a balancing process. CT shows airless but volume-maintained (drowned) left lung with only a little pleural effusion, and on the right, non-opacified tubular structures accompanying the pulmonary arteries representing aspirate-filled bronchial casts, with a small amount of aspiration bronchiolitis.
Key takeaways
Massive aspiration in a patient with a poor cough from neuromuscular disease can produce drowned lung, airless but volume-maintained, with a whiteout that is less shifted than expected for pure collapse because of the filling material. Extensive non-opacified tubular structures paralleling the pulmonary arteries represent aspirate-filled bronchial casts, an unusually dramatic manifestation of central bronchial filling with relatively little accompanying aspiration bronchiolitis.
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