An uncommon etiological factor for aspiration pneumonitis caused by spontaneous sphenoid sinus meningoencephalocele with cerebrospinal fluid rhinorrhea: a case report

Abstract

Background: Aspiration pneumonitis is an inflammatory disease of the lungs which is difficult to diagnose accurately. Large-volume aspiration of oropharyngeal or gastric contents is essential for the development of aspiration pneumonitis. The role of cerebrospinal fluid (CSF) rhinorrhea is often underestimated as a rare etiological factor for aspiration in the diagnosis process of aspiration pneumonitis.

Case presentation: We present a case of a patient with 4 weeks of right-sided watery rhinorrhea accompanied by intermittent postnasal drip and dry cough as the main symptoms. Combined with clinical symptoms, imaging examination of the sinuses, and laboratory examination of nasal secretions, she was initially diagnosed as spontaneous sphenoid sinus meningoencephalocele with CSF rhinorrhea, and intraoperative endoscopic findings and postoperative pathology also confirmed this diagnosis. Her chest computed tomography showed multiple flocculent ground glass density shadows in both lungs on admission. The patient underwent endoscopic resection of meningoencephalocele and repair of skull base defect after she was ruled out of viral pneumonitis. Symptoms of rhinorrhea and dry cough disappeared, and pneumonitis was improved 1 week after surgery and cured 2 months after surgery. Persistent CSF rhinorrhea caused by spontaneous sphenoid sinus meningoencephalocele was eventually found to be a major etiology for aspiration pneumonitis although the absence of typical symptoms and well-defined risk factors for aspiration, such as dysphagia, impaired cough reflex and reflux diseases.

Conclusions: We report a rare case of aspiration pneumonitis caused by spontaneous sphenoid sinus meningoencephalocele with CSF rhinorrhea, which can bring more attention and understanding to the uncommon etiology for aspiration, so as to make more accurate diagnosis of the disease and early surgical treatment.

Keywords: Aspiration pneumonitis; Etiology; Meningoencephalocele; Postnasal drip; Sphenoid sinus.

Fig. 1

Preoperative endoscopy image and sinus computed tomography (CT) scan. a Preoperative endoscopy image. The blue arrow indicates the persistent flow of cerebrospinal fluid (CSF) backwards into the right posterior nostril. b Sinus CT scan. The black arrow indicates the place of lesion tissue protruding into right sphenoid sinus

Fig. 2

Endoscopy images. a Intraoperative endoscopy image. The blue arrow points to the lesion tissue and skull base defect in the lateral wall of the right sphenoid sinus. b Endoscopy image 2 months after surgery. The black arrow indicates repaired area of the skull base defect

Fig. 3

Chest CT images. a Preoperative chest CT image. b Chest CT image 1 week after surgery. c Chest CT image 2 months after surgery

Fig. 4

Changes of infection-related inflammatory indexes such as white blood cells (WBC), neutrophils and c-reactive protein (CRP) after surgery