PDF(Pubmed)
Abstract：
Aspiration pneumonitis is an inflammatory lung disease caused by the inhalation of oropharyngeal secretions colonized by pathogenic bacteria. Accurate diagnosis of aspiration pneumonitis can be challenging, and cerebrospinal fluid (CSF) rhinorrhea is often overlooked as a rare cause of aspiration. In this case report, we present the case of a 48-year-old male patient who experienced right-sided nasal flow of clear watery secretions for 6 months, accompanied by a dry cough as the major symptom. Through comprehensive assessment of clinical symptoms, sinus imaging, nasal endoscopy, and relevant laboratory testing, a presumptive diagnosis of traumatic cribriform plate fracture with CSF rhinorrhea was made. Chest imaging revealed flocculent ground glass shadows in the bilateral lungs. After ruling out viral pneumonia, nasal endoscopic repair of the skull base defect was performed. The patient\'s dry cough and rhinorrhea symptoms resolved within 1 week after surgery, and the pneumonia showed significant improvement and complete resolution within 2 weeks postoperatively. Despite the absence of characteristic symptoms and evident inhalation factors, chronic CSF rhinorrhea caused by the cribriform plate fracture was ultimately identified as the primary etiology of the patient\'s aspiration pneumonitis. This rare case highlights the importance of considering traumatic CSF rhinorrhea as an uncommon cause of aspiration, which can enhance physicians\' awareness and focus on the less-common etiologies of aspiration. Such awareness can contribute to more accurate diagnosis and early operative intervention, particularly in the context of the coronavirus disease 2019 pandemic.
摘要：
吸入性肺炎是由病原菌定植的口咽部分泌物吸入引起的炎症性肺部疾病。吸入性肺炎的准确诊断可能具有挑战性，和脑脊液（CSF）鼻漏通常被忽略为一种罕见的误吸原因。在这个案例报告中,我们介绍了一名48岁的男性患者，他经历了6个月的右侧鼻腔透明的水样分泌物流，伴有干咳为主要症状。通过对临床症状的综合评估,鼻窦成像,鼻内窥镜检查,和相关的实验室测试，推测诊断为外伤性筛状钢板骨折伴脑脊液鼻漏。胸部成像显示双肺有絮凝的毛玻璃阴影。排除病毒性肺炎后,鼻内镜下修复颅底缺损。患者的干咳和鼻漏症状在手术后1周内消失，肺炎在术后2周内表现出显着的改善和完全缓解。尽管没有特征性症状和明显的吸入因素，由筛状钢板骨折引起的慢性CSF鼻漏最终被确定为患者吸入性肺炎的主要病因。这个罕见的病例强调了将外伤性CSF鼻漏视为不常见的误吸原因的重要性，这可以提高医生的意识，并关注不太常见的误吸病因。这种意识可以有助于更准确的诊断和早期手术干预，特别是在2019年冠状病毒疾病大流行的背景下。
