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Left lung abscess due to increased ventilation-perfusion ratio of the left lung
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Left lung abscess due to the left main bronchus being located superior to the right main bronchus
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Right lung abscess due to increased anterior-posterior diameter of the right lung
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Right lung abscess due to the right main bronchus being wider and more vertically oriented
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Mediastinal abscess located between vertebral levels T1-T3
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Aspirated material is more likely to lodge in the right main bronchus. This is due to the anatomy of the right bronchus, which is shorter in length, wider in diameter, and oriented in a more vertical position compared to the left main bronchus. Aspiration pneumonia typically leads to a lung abscess, which is visible on chest x-ray as a cavitating lesion with an associated air-fluid level. Overall, right-sided abscesses are much more common than those on the left due to the inherent anatomical differences between the 2 sides of the body. Within the right lung itself, the most likely location of the abscess does vary among the various lobes depending on the position of the patient. It should be noted that it is possible to aspirate into the left lung as well, particularly if the patient is lying on their left side. Vincent and Goldman describe the presentation of aspiration pneumonia. Anaerobic lung infections are most commonly caused by aspiration. Patients present with fever, weight loss, malaise and productive cough with foul-smelling sputum. Risk factors include altered mental status, history of seizure, general anesthesia, neuromuscular disease stroke, and impaired swallowing. Mukherjee and Paul review foreign body aspiration. Because of its anatomic alignment with the trachea, the most common site is the right bronchus. Hagan and Hardy review lung abscesses. Most common localization was the right lower lobe (29.0%), followed by the right upper lobe (28.4%), left lower lobe (21.3%), left upper lobe (14.2%), and right middle lobe (7.1%). Illustration A depicts normal bronchial anatomy. Note how the right main bronchus is shorter, wider, and more vertically oriented in comparison to the left main bronchus. Incorrect answers: Answer 1: Right-sided abscess is most common in aspiration pneumonia. The ventilation-perfusion ratio does not significantly affect the path of travel of aspirated contents. Answer 2: Right-sided abscess is most common in aspiration pneumonia. The right and left main bronchi split from the trachea at the same anatomical level - one is not located superior to the other. Answer 3: Although right-sided abscess is most common in aspiration pneumonia, the anterior-posterior diameter of the lung does not influence the path of aspirated material into the right lung. Answer 5: A mediastinal abscess at such a high vertebral level as T1-T3 is not expected to be seen in aspiration pneumonia.
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