EpistemisSingle right basal velcro-type crackles
Specialty: Respiratory.
Why it occurs
- Fibrotic sequelae located in the right base secondary to pneumonia due to repetitive aspiration of gastric or nutritional contents (the right lower lobe is the most common anatomical destination of aspirations due to the more vertical arrangement of the right main bronchus, generating chronic organizing pneumonia and subsequent localized fibrosis)
- Post-infectious pulmonary fibrosis due to lung abscess or right lower lobar empyema
- Asymmetric interstitial pneumopathy with initial involvement of the right base
- Right actinic pneumonitis secondary to targeted radiotherapy for right bronchial carcinoma or right breast cancer.
Initial workup
High-resolution chest computed tomography (CT) (HRCT); Study of swallowing with videofluoroscopy (search for microaspirations); Flexible bronchoscopy with bronchoalveolar lavage and complete microbiological culture; Forced spirometry and DLCO to evaluate functional impact.
red flags
Recurrent fever accompanied by fetid purulent sputum (suggestive of bacterial superinfection in sequelae fibrotic parenchyma), frank dysphagia with episodes of choking that justify persistent microaspirations, progressive dyspnea at rest, or arterial desaturation on exercise.
Standard management
- Treatment depends on controlling the triggering cause — p. e.g., treatment of dysphagia and food thickeners to prevent aspiration
- Amoxicillin/Clavulanic — 875/125 mg orally every 8 hours for 10-14 days if there is suspicion of bacterial bronchial superinfection
- Nintedanib (150 mg every 12 hours in case of diffuse fibrosing progression).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Respiratory
- Listed causes
- 4
- Treatment options
- 3