On examination, focal or diffuse crackles and wheezing are common Cyanosis may appear with more severe disease CXRs ( Fig 99.1 ) may show either localized or diffuse infiltrates, which may be unilateral or bilateral The CXR of a patient who has aspirated may evolve from normal to complete bilateral opacification within several hours It can be difficult to distinguish aspiration pneumonitis from pneumonia earlier in the clinical course