Aspiration Pneumonia

JO-ANN ALMADRONES
 DISEASE DESCRIPTION
• Aspiration pneumonia is a pulmonary infection characterized
by inflammation and necrosis due to inhalation of foreign
material. The severity of the inflammatory response depends
on the material aspirated, the type of bacteria aspirated, and
the distribution of aspirated material in the lungs.
 DISEASE SYNONYMS

• Foreign-body pneumonia,
• Inhalation pneumonia,
• Gangrenous pneumonia
 DISEASE ETIOLOGY

• Inappropriate administration of therapeutic agents is a

common cause of aspiration pneumonia in large animals
and less common in dogs and cats. Liquids given by drench
or dose syringe should not be delivered faster than the
animal can swallow. Drenching is particularly dangerous
when the animal’s tongue is drawn out, when the head is
held high, or when the animal is coughing or bellowing.
 SIGNALMENT

• Multiple sclerosis
• Parkinson’s disease
• Myasthenia gravis
• Bulbar or pseudo bulbar palsy
 DISEASE PATHOGENESIS
• In sheep, poor dipping technique with repeated immersion of the animal’s head
may cause aspiration of fluid. Calves and lambs may inhale inflammatory debris
if affected with diphtheritic stomatitis/laryngitis. The muscles of deglutition may
be affected in lambs with nutritional myopathy. Pigs fed fine particulate food in
dry environments may inhale feed granules. Aspiration pneumonia in cattle after
treatment for milk fever is usually fatal. Cervids affected with chronic wasting
disease may develop aspiration pneumonia due to CNS dysfunction. In dogs and
less frequently in cats, aspiration pneumonia is generally associated with
inhalation of oral ingesta, regurgitated material, or vomitus. Common risk factors
for dogs and cats include pharyngeal abnormalities (cricopharyngeal motor
dysfunction), esophageal diseases (megaesophagus, gastroesophageal reflux
disease, esophageal obstruction), weakened clinical condition, and anesthesia or
heavy sedation. Bacteria in aspirated material may initiate acute infection or
secondary infection later in disease.
• In sheep, poor dipping technique with repeated immersion of the animal’s
head may cause aspiration of fluid. Calves and lambs may inhale
inflammatory debris if affected with diphtheritic stomatitis/laryngitis. The
muscles of deglutition may be affected in lambs with nutritional myopathy.
Pigs fed fine particulate food in dry environments may inhale feed granules.
Aspiration pneumonia in cattle after treatment for milk fever is usually
fatal. Cervids affected with chronic wasting disease may develop aspiration
pneumonia due to CNS dysfunction. In dogs and less frequently in cats,
aspiration pneumonia is generally associated with inhalation of oral ingesta,
regurgitated material, or vomitus. Common risk factors for dogs and cats
include pharyngeal abnormalities (cricopharyngeal motor dysfunction),
esophageal diseases (megaesophagus, gastroesophageal reflux disease,
esophageal obstruction), weakened clinical condition, and anesthesia or
heavy sedation. Bacteria in aspirated material may initiate acute infection or
secondary infection later in disease.
Clinical Findings

• Superficial consolidated lung and overlying lesions of fibrous pleurisy

can readily be identified on ultrasound examination using either linear
or sector probes connected to 5-MHz machines; pleuritic friction rubs
are not audible on auscultation. In dogs and cats, clinical signs may be
peracute, acute, or chronic. Cough, dyspnea, tachypnea, or exercise
intolerance are seen most frequently. Thoracic radiographs generally
show a bronchoalveolar pattern in gravity-dependent ventral lung
lobes (right cranial and middle and left cranial lobes); however,
radiographic changes may not be seen until 24 hr after acute
aspiration
• Jersey cow with unilateral
inhalation pneumonia caused
by inhalation of rumen
contents after becoming cast
in lateral recumbency while
suffering from hypocalcemia.
Profound toxemia, arched
back, and bilateral purulent
nasal discharge are evident.
 Lesions:
• Aspiration pneumonia is usually in the anteroventral parts of
the lung; it may be unilateral in animals in which lateral
recumbency was the cause of aspiration, or bilateral and
centered on airways. In early stages, the lungs are markedly
congested with areas of interlobular edema. Bronchi are
hyperemic and full of froth. The pneumonic areas tend to be
cone-shaped, with the base toward the pleura. Suppuration
and necrosis follow. The foci become soft or liquefied,
reddish brown, and foul smelling. There usually is an acute
fibrinous pleuritis, often with pleural exudate. Animals that
survive develop chronic abscesses and fibrous adhesions
between the visceral and parietal pleura.
• Severe chronic
necrotizing pneumonia
of the lung of a cow
after inhalation of rumen
contents
• Acute fibrinous pleuritis
associated with inhalation
pneumonia in a cow.
 DIAGNOSIS
• A history suggesting recent foreign body aspiration within the past 1–2 days
is of greatest value for a diagnosis of aspiration pneumonia. Affected
animals separate from the rest of the group and present with pyrexia 104°–
105°F (40°–40.5°C), a painful expression, arched back, inappetance,
depression, toxic mucous membranes, and an increased respiratory rate
(>40–60 breaths/min) with a shallow abdominal component. This is often
associated with a purulent nasal discharge that sometimes is tinged reddish
brown or green. Milk yield is greatly reduced to zero in lactating animals.
Thoracic auscultation reveals reduced lung sounds over affected
consolidated lung, with increased breath sounds over normal lung. In cows
that aspirate ruminal contents as a consequence of becoming cast with
hypocalcemia, toxemia is usually fatal within 1–2 days.
DIFFERENTIAL DIAGNOSIS
Bronchitis
Mycoplasma pneumonia
Chronic obstructive pulmonary disease
characterized by depression and toxemia. A
combination of clinical signs of depression and fever
(104°–106°F [40°–41°C]), without any signs
attributable to other body systems,
M haemolytica in the upper respiratory tract increases
rapidly,
Lung lesions of feedlot cattle, and cause a purulent
bronchopneumonia.
abored breathing and coughing, and physical
examination may reveal abnormal breath sounds such
as wheezes and crackles. The area of thoracic
auscultation is typically enlarged due to lung
hyperinflation.
 Prevention and Treatment:
• Broad-spectrum antibiotics should be used in animals known to have
inhaled a foreign substance without waiting for signs of pneumonia to
appear; however, this rarely occurs in farm animals presented with
severe clinical signs. A transtracheal wash can help identify the
causative agent for which an antibiotic sensitivity can be obtained. Care
and supportive treatment include NSAIDs such as flunixin meglumine.
In small animals, oxygen therapy can be useful. Saline nebulization and
coupage may assist with generating a productive cough to facilitate
clearance of the aspirated material. Despite all treatments, prognosis is
poor, and efforts must be directed at prevention.