Most patients who develop pulmonary toxicity after hydrocarbon ingestion will have an episode of coughing, gagging, and choking. This occurs shortly after ingestion, usually within 30 minutes, and is presumptive evidence of aspiration. Manifestations include rales, rhonchi, bronchospasm, tachypnea, hypoxia, hemoptysis, acute lung injury (hemorrhagic or nonhemorrhagic), and signs of respiratory distress. Clinical findings often worsen over several days but typically resolve within 5-7 days. Radiographic evidence of pneumonitis develops as early as 15 minutes or as late as 24 hours after exposure. Chest radiographs performed immediately on initial presentation are not useful in predicting infiltrates in either symptomatic or asymptomatic patients. Radiographic changes often progress over several days, typically reaching a maximum at 5-7 days, with resolution over several weeks. Radiographic resolution does not correlate with clinical improvement and usually lags behind by several days to weeks.

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