Aspiration of Barium Contrast by a Geriatric Patient with Gastroparesis (original) (raw)
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Case Report: Two-year consequences of barium sulfate aspiration
F1000Research
Aspiration of barium contrast is a rare, but well-known, event occurring during examinations of the upper gastrointestinal system using contrast media. We present a case of large-volume high-concentration barium sulfate aspiration in an 88-year-old male diagnosed with dysphagia, during the swallowing study. He rapidly developed difficulty in breathing, hypoxemia and chemical pneumonitis. The chest radiograph showed the infiltration of barium contrast at both sides with left lower lung predominance. His lowest oxygen saturation by pulse oximetry was 91%. His condition improved with supportive care including oxygen therapy. The patient was finally discharged a few days later with normal oxygen saturation by pulse oximetry. The follow-up chest radiograph at 2 years after the aspiration showed considerable interval clearing of the aspirated contrast material. The plasma and urine barium concentrations at 2 years after the aspiration were <0.5 μg/L and 13.6 μg/L, respectively. Current...
An Esophagogram or Tracheobronchogram? A Review of Barium Sulfate Aspiration
Journal of investigative medicine high impact case reports
The barium swallow is an important radiological investigation used for the diagnosis of upper gastrointestinal anatomical disorders like esophageal cancer, diverticulum, achalasia, foreign body, among others. Generally, it is believed to be a safe technique with rare complications, but few cases of barium sulfate aspiration have been reported in the literature with multiple complications. We are reporting a case of an elderly male who underwent esophagogram for the workup of chronic dysphagia, aspirated barium sulfate, and went into respiratory failure and circulatory shock several hours later. Moreover, we also did a systematic literature search and reviewed all available articles on aspiration of barium sulfate and its potential complications. We focused on predisposing factors for aspiration, clinical presentation, complications after aspiration, and prognosis with the aim to better understand and manage this condition.
Barium sulfate aspiration: Is early bronchioalveolar lavage a life-saving procedure?
Turkish Journal of Emergency Medicine, 2020
Aspiration of barium sulfate is a well-known complication, occurring accidentally during contrast-enhanced examinations of the upper gastrointestinal system. Massive aspiration of contrast material causes mechanical obstruction that increases alveolar dead space leading to altered ventilation/perfusion (V/Q) ratio with secondary respiratory failure and death. The potential treatment strategies include early recognition of predisposing factors, pretreatment with antireflux medications, such as domperidone, correct choice of contrast media, and use of retroesophageal suction catheter during barium swallow study. We report a case of barium swallow aspiration, which was successfully managed by early institution of bronchioalveolar lavage (BAL) and positive pressure mechanical ventilation. Till date, BAL has not been recommended for the same, with studies showing it can worsen the clinical scenario.
Clinical and Radiological Dissociation in Massive Barium Aspiration
Cureus, 2021
Barium studies are commonly used to rule out gastrointestinal (GI) pathologies and sometimes they are associated with complications such as barium aspiration with heterogeneity in clinical features ranging from mild to severe symptoms. We present a case of large volume barium aspiration in a 73-year-old male with past medical history of dysphagia diagnosed with diffuse esophageal spasm. Barium is an inert material commonly used for GI tract study. Although complications associated with barium studies are rare, aspiration of barium can have dramatic findings resulting in mild to severe symptoms. Clinically patient had very minimal symptoms but radiographic studies appeared dramatic. Therefore, a clinical and radiographic paradox must be kept in mind when evaluating patients and reviewing large volume barium aspiration imaging. Our case remained asymptomatic and had no respiratory complaints, nor did he develop any respiratory distress post barium aspiration.
Jornal Brasileiro de Pneumologia, 2013
Objective: To assess the routine use of barium swallow study in patients with chronic cough. Methods: Between October of 2011 and March of 2012, 95 consecutive patients submitted to chest X-ray due to chronic cough (duration > 8 weeks) were included in the study. For study purposes, additional images were obtained immediately after the oral administration of 5 mL of a 5% barium sulfate suspension. Two radiologists systematically evaluated all of the images in order to identify any pathological changes. Fisher's exact test and the chi-square test for categorical data were used in the comparisons. Results: The images taken immediately after barium swallow revealed significant pathological conditions that were potentially related to chronic cough in 12 (12.6%) of the 95 patients. These conditions, which included diaphragmatic hiatal hernia, esophageal neoplasm, achalasia, esophageal diverticulum, and abnormal esophageal dilatation, were not detected on the images taken without contrast. After appropriate treatment, the symptoms disappeared in 11 (91.6%) of the patients, whereas the treatment was ineffective in 1 (8.4%). We observed no complications related to barium swallow, such as contrast aspiration. Conclusions: Barium swallow improved the detection of significant radiographic findings related to chronic cough in 11.5% of patients. These initial findings suggest that the routine use of barium swallow can significantly increase the sensitivity of chest X-rays in the detection of chronic cough-related etiologies.
Canadian Journal of Medical Radiation Technology, 2003
Barium sulphate is considered a safe and efficacious contrast medium that is routinely used for radiologic examinations of the gastrointestinal tract. Although the examinations rarely result in complications, the technique is moderately invasive and not entirely innocuous. Complications resulting from the procedures, and adverse reactions from the barium itself, have ranged from mild to severe and in rare instances have led to patient death. This paper reviews the clinical application, biological requirements and clinical properties of barium sulphate contrast media used in diagnostic x-ray imaging. It also outlines the risk factors and associated adverse reactions and complications involved with the use of barium sulphate, and presents documented cases where iatrogenic injuries have resulted.
Pulmonology and Respiratory Research
The barium is often used in radiocontrast examinations of the digestive system because of mucosal absorption is limited. Massive barium aspiration is a rare complication, especially when there is no anatomic or neurological defi cit. The depending on barium concentration can cause various lung effects. When the literature is reviewed, barium aspiration may be asymptomatic or lethal in massive amounts. Rarely, large amounts of barium sulphate are aspirated into the lung, there is no literature study how often this is happening. We present a case of massive barium aspiration in this subject. The case is related to a patient's diagnostic esophagography who complaints swallowing problems. The massive barium aspiration couldn't notice because of the absence of acute symptoms and surgical operation of gastrointestinal tract which the patient had undergone previously. When the patient applied our Pediatric Chest Diseases Polyclinic after three months, as a result of the examinations and deep research it was understood that the case was about massive barium aspiration. The patient was directed to our center because there was a radiological appearance of bone density signs on chest X-ray. Such a complaint was not reported by the family neighter in his biography, nor was written in the epicrisis. We will share acute and chronic changes in the lungs, diagnosis and treatment approaches of this case. The infant who has ileostomy was previously operated because of necrotizing enterocolitis. And also still has severe gastro-esophageal refl ux and under conservative and medical treatment, a possible fundoplication surgery is planning.
The Laryngoscope, 2000
Objective: Aspiration pneumonia is a significant cause of morbidity and mortality in both acute and long-term care settings. While there are many reasons for patients to develop aspiration pneumonia, there exists a strong association between difficulty swallowing, or dysphagia, and the development of aspiration pneumonia. The modified barium swallow test (MBS) and endoscopic evaluations of swallowing are considered to be the most comprehensive tests used to evaluate and manage patients with dysphagia in an effort to reduce the incidence of pneumonia. The purpose of this study was to provide an initial investigation of whether flexible endoscopic evaluation of swallowing with sensory testing (FEESST) or MBS is superior as the diagnostic test for evaluating and guiding the behavioral and dietary management of outpatients with dysphagia. FEESST combines the standard endoscopic evaluation of swallowing with a technique that determines laryngopharyngeal sensory discrimination thresholds by endoscopically delivering air pulse stimuli to the mucosa innervated by the superior laryngeal nerve. Study Design: Randomized, prospective cohort outcome study in a hospitalbased outpatient setting. Methods: One hundred twenty-six outpatients with dysphagia were randomly assigned to either FEESST or MBS as the diagnostic test used to guide dietary and behavioral management (postural changes, small bites and sips, throat clearing). The outcome variables were pneumonia incidence and pneumonia-free interval. The patients were enrolled for 1 year and followed for 1 year. Results: Seventy-eight MBS examinations were performed in 76 patients with 14 patients (18.4%) developing pneumonia; 61 FEESST examinations were performed in 50 patients with 6 patients (12.0%) developing pneumonia. These differences were not statistically significant ( 2 ؍ 0.93, P ؍ .33). In the MBS group the median pneumonia-free interval was 47 days; in the FEESST group the median pneumoniafree interval was 39 days. Based on Wilcoxon's signedrank test, this difference was not statistically significant (z ؍ 0.04, P ؍ .96). Conclusion: Whether dysphagic outpatients have their dietary and behavioral management guided by the results of MBS or of FEESST, their outcomes with respect to pneumonia incidence and pneumonia-free interval are essentially the same.
Middle-aged woman with dysphagia to solid
Saudi Journal of Gastroenterology, 2014
A 45-year-old woman presented to the surgery outpatient department with complaints of difficulty in swallowing, predominantly solid food, for the past 6 months. She had lost about 7 kg weight in the last 3 months due to difficulty in food intake since the patient was mostly on liquid diet. She had no history of chronic heartburn, smoking, fever, or altered bowel habits. Routine blood investigations were within normal limits. She was advised barium swallow and subsequently was advised contrast-enhanced computed tomography (CECT) thorax. Barium swallow showed smooth external indentation on the esophagus, predominantly from right side and from posterior aspect with slight hold up of contrast [ ]. There was no evidence of stricture or mucosal irregularity. CECT thorax confirmed the barium findings and the diagnosis [ ].