Background:Aspiration pneumonia(AP) is a clinical diagnosis, and its diagnostic methods have not yet been established. Since AP's computed tomography(CT) image findings are variable, with no typical findings, its diagnosis is often difficult. We reported that elevated levels of bronchoalveolar lavage(BAL) amylase and pepsin might be valuable biomarkers for AP. Here, we investigated the association between these biomarkers and high-resolution(HR) CT  image findings in AP. Methods:We reviewed HRCT images of 48 AP patients among 327 adult patients who underwent clinically-indicated bronchoscopy at Aizu Medical Center, Japan. HRCT image findings were analyzed in relation to elevated BAL amylase and pepsin levels reported in our previous study(Suzuki T et al. Pulmonology, 2022 S2531-0437(22)00104-0). Results:HRCT image findings of AP were as follows: consolidation in 35 cases, pleural effusion in six patients, bronchiolitis in 13 cases, crazy-paving appearance in 2 cases, ground-glass appearance in 16 cases, a subpleural curvilinear shadow in 27 cases, and bronchiectasis in 21 patients. Evaluation of the associations between these findings and BAL amylase and pepsin showed that the subpleural curvilinear shadow tended to be seen in patients with high BAL amylase levels. Esophageal dilatation was observed as another interesting HRCT image finding of AP. Maximum esophageal diameter was significantly wider in the AP group than in the non-AP group(13. 8mm and 9.8mm, respectively). Further, this tendency was observed mainly in patients with high BAL pepsin levels. Conclusion:AP?s HRCT image findings might correlate with BAL amylase and pepsin, which might help diagnose AP.