title: [A retrospective clinicopathological study of aspiration pneumonia in the elderly].
abstract: OBJECTIVE
  To explore the clinicopathological characteristics of aspiration pneumonia in the elderly.
  
  
  METHODS
  The clinical data of 30 cases of autopsy-proven aspiration pneumonia in Beijing Hospital from 1973 to 2002 were reviewed. The patients consisted of 28 males and 2 females, aged from 63 to 103 [mean (83 ± 9)] years.
  
  
  RESULTS
  Only 15 cases were clinically diagnosed as aspiration pneumonia before death. Concomitant diseases were severe and complex, mostly coronary disease, cerebrovascular disease, hypertension, COPD, and diabetes mellitus. All the patients suffered from at least 3 concomitant diseases. Long-term bedridden and nasogastric feeding was seen in 11 and 17 patients respectively. The clinical presentation and chest X-ray of aspiration pneumonia in the elderly were nonspecific and variable. Mixed infections were common . The main bacteria isolated were Gram-negative bacilli, in particular Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Escherichia coli and Candida albicans. By pathology, macrophages with foreign bodies were found in all the 30 cases and multiple small abscesses were found in 14 cases. The lesions were adjacent to the bronchioles and in the lung tissue around the bronchioles, mostly multi-lobar and bilateral. Unilateral or bilateral pleural effusion developed in 20 patients. The accordance between radiological and pathological diagnosis of aspiration pneumonia was very poor. The foci of infection detected by X-ray were proven by autopsy in 13 patients, while pleural effusions in X-ray were proven by autopsy in 15 patients.
  
  
  CONCLUSIONS
  Multi-concomitant diseases, mixed infection and extra-pulmonary presentations were common in elderly patients with aspiration pneumonia. Multiple small abscesses were the pathological characteristics of aspiration pneumonia in the aged. A definite clinical diagnosis of aspiration pneumonia was difficult. Recurrent silent microaspiration was a feature of aspiration in the elderly. The assessment of risk factor of aspiration played an important role in the clinical diagnosis of aspiration pneumonia.
authors.affiliation: Department of Respiratory and Critical Care Medicine,Beijing Hospital,Beijing 100730, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Pu
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Zhong
authors.forename: Fang
authors.initials: F
authors.lastname: Fang
authors.forename: Yimeng
authors.initials: Y
authors.lastname: Yang
authors.forename: Xiaomao
authors.initials: X
authors.lastname: Xu
authors.affiliation: Email: suntieying3@hotmail.com.
authors.forename: Tieying
authors.initials: T
authors.lastname: Sun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000150:complications; D005260:Female; D005547:Foreign Bodies / Q000150:complications; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000150:complications; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000209:etiology / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors