Aspiration Pneumonitis with Nasal Liquorrhea. Literature Review

Damage to the meninges in combination with the presence of a defect in the bone structures of the base of the skull and the formation of communication with the nasal cavity or paranasal sinuses are necessary conditions for nasal liquorrhea. There are a number of complications of nasal liquorrhea of various origins: infectious (meningitis, brain abscess), pneumocephalus, aspiration pneumonitis and gastritis. A review of the literature related to aspiration pneumonitis in nasal liquorrhea has been carried out. 4 articles were selected with descriptions of 9 cases. The analysis of demographic indicators of patients, clinical data, treatment characteristics was carried out. Based on the analysis of the literature, aspiration pneumonitis is a rare complication of nasal liquorrhea. For differential diagnosis with other types of pneumonitis, it is necessary to rely on additional clinical data, such as unilateral discharge of clear fluid from the nose when tilting the head, worsening of the condition and intensification of symptoms in a horizontal position, absence of systemic inflammatory response syndrome, ineffectiveness of antibiotic therapy, recurrent the nature of the flow. Antibiotic therapy does not cure the patient from pneumonitis. For the treatment of this pathology, it is first of all necessary to eliminate the cause of aspiration — to perform plastic surgery of the skull base defect in the absence of contraindications from the side of anesthetic aid.

1. Субханов К.С., Алексеев Д.Е., Черебилло В.Ю. и др. Современный взгляд на комплексную диагностику ликвореи. Вестник военно-медицинской академии. 2018; 64(4): 223-226. Subhanov K.S., Alekseev D.E., CHerebillo V.YU. et al. A modern view of the complex diagnosis of liquorrhea. Vestnik voennomedicinskoj akademii. 2018; 64(4): 223-226. [in Russian]

2. Abuabara A. Cerebrospinal fluid rhinorrhoea: diagnosis and management. Med Oral Patol Oral Cir Bucal. 2007; 12(5): E397-400.

3. Wang E.W., Vandergrift W.A., Schlosser R.J. Spontaneous CSF leaks. Otolaryngol Clin North Am. 2011; 44(4): 845-856. doi:10.1016/j.otc.2011.06.018.

4. Капитанов Д.Н., Лопатин А.С., Потапов А.А. Эндоскопическая диагностика и лечение назальной ликвореи. M. Практическая медицина. 2015; 184-191. Kapitanov D.N., Lopatin A.S. Potapov A.A. Endoscopic diagnosis and treatment of nasal liquorrhea. M, Practical medicine 2015; 184-191. [in Russian].

5. Edwin Dias, Meena Dias. Recurrent meningitis in a child with intranasal ncephalocele. J Neurosci Rural Pract. 2012; 3(1): 102–103. doi: 10.4103/0976-3147.91981.

6. Ferran Morell, Iñigo Ojanguren, María-Jesús Cruz Diagnosis of occupational hypersensitivity pneumonitis Curr Opin Allergy Clin Immunol. 2019; 19(2): 105-110. doi: 10.1097/ ACI.0000000000000511.

7. Авдеев С.Н. Аспирационная пневмония: современные подходы к диагностике и терапии. Пульмонология. 2009; (2): 5-19. doi: 10.18093/0869-0189-2009-2-5-19. Avdeev S.N. Aspiration pneumonia: modern approaches to diagnosis and therapy. Pulmonology 2009;(2):5-19. doi: 0.18093/0869-0189-2009-2-5-19. [in Russian]

8. Seltzer J., Babadjouni A., Wrobel B.B. et al. Resolution of chronic aspiration pneumonitis following endoscopic endonasal repair of spontaneous cerebrospinal fluid fistula of the skull base. J Neurol Surg Rep. 2016;77(2):73-76. doi: 10.1055/s-0036-1582238.

9. A.K. Mahapatra A. Suri Anterior Encephaloceles: A Study of 92 Cases Pediatr Neurosurg. 2002; 36: 113-118. doi: 10.1159/000048365.

10. Mishra S.K., Mathew G.A., Paul R.R. et al. Endoscopic Repair of CSF Rhinorrhea: An Institutional Experience. Iran J Otorhinolaryngol. 2016; 28(84): 39-43.

11. Maya Or, Ian A. Buchanan, Saman Sizdahkhani et al. Chronic Aspiration Pneumonitis Caused by Spontaneous Cerebrospinal Fluid Fistulae of the Skull Base. Laryngoscope. 2021; 131(3): 462-466. doi: 10.1002/lary.28757.

12. Mark G. Jones, Kevin O. Leslie, Neeta Singh, et al. Dyspnoea, rhinorrhoea and pulmonary infiltrates in a healthy young woman Thorax. 2013; 68: 791–793 doi:10.1136/thoraxjnl-2012-202564.

13. Sanjiwika Lalanjani Wasgewatta, Nathan Manning, Michael Redmond et al. Spontaneous cerebrospinal fluid rhinorrhoea and aspiration pneumonitis following initiation of continuous positive airway pressure treatment for obstructive sleep apnoea Respirology Case Reports. 2019: 7(6): e00435. doi: 10.1002/rcr2.435.

14. Marik P.E. Pulmonary aspiration syndromes. Curr Opin Pulm Med. 2011; 17(3): 148-154. doi: 10.1097/mcp.0b013e32834397d6.

15. LeVay A.J., Kveton J.F. Relationship between obesity, obstructive sleep apnea, and spontaneous cerebrospinal fluid otorrhea. Laryngoscope. 2008; 118(2): 275-278. doi: 10.1097/mlg.0b013e31815937a6.

16. Nelson R.F., Gantz B.J., Hansen M.R. The rising incidence of spontaneous cerebrospinal fluid leaks in the United States and the association with obesity and obstructive sleep apnea. Otol Neurotol. 2015; 36(3): 476-480. doi: 10.1097/mao.0000000000000535.

17. Bakhsheshian J., Hwang M.S., Friedman M. Association between obstructive sleep apnea and spontaneous cerebrospinal fluid leaks: a systematic review and metaanalysis. JAMA Otolaryngol. Head Neck Surg. 2015; 141(8): 733-738. doi: 10.1001/jamaoto.2015.1128.

18. Yared J., El. Annan J. Cerebrospinal fluid leak associated with nasal continuous positive airway pressure treatment for obstructive sleep apnoea. BMJ Case Rep. 2010:bcr0120102659. doi: 10.1136/bcr.01.2010.2659.

19. Kuzniar T.J., Gruber B., Mutlu G.M. Cerebrospinal fluid leak and meningitis associated with nasal continuous positive airway pressure therapy. Chest. 2005; 128(3): 1882-1884. doi: 10.1378/chest.128.3.1882.

20. Mario A. Pérez, Omer Y. Bialer, Beau B. Bruce et al. Primary spontaneous cerebrospinal fluid leaks and idiopathic intracranial hypertension. J. Neuroophthalmol. 2013; 33(4): 330-337. doi: 10.1097/wno.0b013e318299c292.

21. Карнаушкина М.А., Аверьянов А.В., Лесняк В.Н. Синдром матового стекла при оценке КТ-изображений органов грудной клетки в практике клинициста: патогенез, значение, дифференциальный диагноз. Архивъ внутренней медицины. 2018; 8(3): 165-175. doi: 10.20514/2226-6704-2018-8-3-165-175. Karnaushkina M.A., Aver’yanov A.V., Lesnyak V.N. Ground-glass opacities syndrome in the assessment of CT images of the chest organs in the clinician’s practice: pathogenesis, significance, differential diagnosis. The Russian Archives of Internal Medicine. 2018; 8(3): 165-175. doi: 10.20514/2226-6704-2018-8-3-165-175. [in Russian]

22. Шелеско Е.В., Кравчук А.Д., Капитанов Д.Н. и др. Современный подход к диагностике назальной ликвореи. Вопросы нейрохирургии имени Н.Н. Бурденко. 2018; 2(3): 103-111. doi: 10.17116/neiro2018823103. Shelesko E.V., Kravchuk A.D., Kapitanov D.N., et al. A modern approach to the diagnosis of nasal liquorrhea. Voprosy nejrohirurgii imeni N.N. Burdenko. 2018; 82(3): 103-111. doi: 10.17116/neiro2018823103. [in Russian]