Correct!
1. Granulomas are a nonspecific finding that can be seen in a large number of disorders
A granuloma is a specific inflammatory response in tissue that usually contains histiocytes, mixed inflammation, and may or may not have giant cells and necrosis. Granulomas result from both noninfectious and infectious causes. Infectious causes include mycobacterial, fungal and some parasitic infections. Noninfectious causes include sarcoidosis, hypersensitivity pneumonitis, some vasculitic disorders, talc, beryllium, bronchocentric granulomatosis and aspiration of food particles.
Aspiration can be a particularly difficult diagnosis especially when it is chronic. Many of the common causes of aspiration such as depressed consciousness, vocal cord dysfunction, dysphagia, gastroesophageal reflux disease, or recurrent vomiting are not present, especially in the elderly (1). Although not elderly, our patient had only gastroesophageal reflux disease to suggest chronic aspiration.
The identification of food particles can be difficult on biopsy. The presence of foreign material on the lung biopsy can be easily overlooked by pathologists (1). In our patient, careful inspection of the lung biopsy revealed the presence of foreign material.
Our patient’s barium swallow revealed severe reflux supporting aspiration as a cause. With airway-centered disease, regardless of the presence of foreign material, aspiration should be considered even in a patient without symptoms.
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