Aspiration is defined as inhalation of oropharyngeal or gastric contents into the pulmonary tree. Depending on the composition of the aspirate, three complications have been described: * Chemical pneumonitis may develop whose severity depends on the pH value and quantity of aspirate. The two lung changes after acid aspiration are: a) direct toxic damage to the respiratory epithelium resulting in interstitial pulmonary edema and b) a few hours later, inflammatory response with production of cytokines, neutrophil infiltration, and macrophage activation. Oxygen-free radicals are generated which, in turn, lead to further lung damage. Patients may remain asymptomatic after acid aspiration. Others may develop dyspnea, pleuritic chest pain, cough, fever, bloody or frothy sputum, and respiratory failure. * Aspiration pneumonia may develop. * The third complication occurs after inhalation of particulate matter that obstructs airways. The patients will have sudden arterial hypoxemia with development of lung atelectasis. Location The location is often gravity dependent, and depends on the person's position. Generally, the right middle and lower lung lobes are the most common sites affected, due to the larger caliber and more vertical orientation of the right mainstem bronchus. People who aspirate while standing can have bilateral lower lung lobe infiltrates. The right upper lobe is a common area of consolidation, where liquids accumulate in a particular region of the lung, in alcoholics who aspirate in the supine position.
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