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Aspiration can be acute, subacute, or chronic. Pulmonary manifestations of aspiration syndromes are diverse. Inspection flexible bronchoscopy has been suggested as diagnostic of acute aspiration based on mucosal changes. Fiberoptic bronchoscopy with bronchoalveolar lavage and the determination of a lipid-laden macrophage index has been suggested as useful in diagnosing chronic aspiration syndromes. We review the literature regarding the utility of bronchoscopy in diagnosing aspiration syndromes.