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July 17, 1972

Aspiration Pneumonia

JAMA. 1972;221(3):301. doi:10.1001/jama.1972.03200160051018

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To the Editor.—  In their recent article, Cameron and Zuidema (219:1194, 1972) appropriately emphasize the problem of aspiration pneumonia and the clinical settings in which it is most apt to occur. I should like to suggest one addition to their litany of likely situations—the unrecognized, forgotten, or ignored sliding esophageal hiatus hernia in the patient undergoing surgery for another condition. Even under normal circumstances the patient with this problem runs some risk of bronchopulmonary aspiration; in the postoperative milieu, the risk is incalculably increased.

Report of a Case.—  A 54-year-old man was admitted to the hospital because an x-ray film of the chest had shown a density in the right upper lung field. Coincident barium study had demonstrated a sliding hiatus hernia with moderate reflux. The usual diagnostic studies included bronchoscopy and were unproductive. Brief consideration was given to the possibility that the lung lesion represented a focus of chronic