A 63-year-old man is admitted to the hospital after suffering a cerebral infarction. A swallow study performed during the acute recovery period shows oropharyngeal dysphagia. Despite being maintained on the appropriate dietary restrictions, the patient experiences an episode of vomiting while lying on his back and subsequently develops pneumonia. Which of the following lung regions is most likely to be affected?

Question

A 63-year-old man is admitted to the hospital after suffering a cerebral infarction.  A swallow study performed during the acute recovery period shows oropharyngeal dysphagia.  Despite being maintained on the appropriate dietary restrictions, the patient experiences an episode of vomiting while lying on his back and subsequently develops pneumonia.  Which of the following lung regions is most likely to be affected?

Quizplus · Accepted Answer

11ec160b_35d9_091e_9249_bb71bfe0f7a5_MD0001_00 Due to gravity, aspiration pneumonia typically develops in the most dependent portions of the lung. Patients who aspirate while lying supine typically have involvement of the posterior segments of the upper lobes and the superior segments of the lower lobes. The right lung is more prone to aspiration than the left lung as the right main bronchus has a larger diameter, is shorter, and is more vertically oriented than the left main bronchus (mnemonic: "Inhale a bite, goes down the right"). (Choice B) Aspiration in an upright position tends to involve the basilar segments of the lower lobes. (Choices C and D) Recumbent patients in the prone position (ie, lying on the abdomen) are more likely to aspirate into the middle lobe and lingula, as these are the most dependent portions of the lung in this position. Educational objective: Due to gravity, supine patients typically aspirate into the posterior segments of the upper lobes and superior segments of the lower lobes. Patients who are upright tend to aspirate into the basilar segments of the lower lobes. Aspirated material is more likely to travel down the right main bronchus.

A 63-Year-Old Man Is Admitted to the Hospital After Suffering