The pulmonary complications of dysphagia.

This paper is concerned with the pulmonary -aspiration phenomena associated with mechanical dysphagia, and the term "dysphagia pneumonitis" is used for the syndrome. Lesions due to central dysphagia and secondary to bronchooesophageal fistulae have been excluded. In 1927 Vinso"n reported a case of achalasia vhich was complicated by a lung abscess, and since then 38 others have been described. These, together with a further collection of nine cases hitherto unpublished, form the basis of this article. After Vinson's paper the majority of reports in the 1930's were published by French otolaryngologists as single unusual histories. But from 1938 onwards more have appeared in the American literature, some have been described by clinicians, and others by radiologists. Weens (1944) collected five and reviewed the literature, BirdAcosta (1944) described a further three, and Hawes and Soule (1945) two cases. Six have been published in the British journals by Cummins and Williams (1933), Schrier (1938), Robson and Wilkinson (1946), and Wooler (1948); others have been described incidentally in reviews of different conditions. Jackson and Jackson (1933), in discussing pulmonary symptoms of oesophageal disease, cite three cases, and Keefer (1934) reported one aspiration lung abscess in a paper describing seventeen examples of oesophageal carcinoma associated with pulmonary lesions. Harrington (1945) and Lahey (1946), in their large series of pharyngeal diverticula, each mention four cases complicated by lung abscesses. The association of dysphagia with the presence of non-pathogenic acid-fast bacilli in the sputum and with lipoid pneumonia has led to the publication of a further six cases (Rothstein and Pirkle, 1946; Baldwin, 1942; Thomas and Jewett, 1936; Warring and Rilance, 1943; Cummins and Williams, 1933 ; Tcherthoff, 1941), and Wooler (1948), in his paper on cardiospasm, refers to three examples of " dysphagia pneumonitis." CASE HISTORIES