Severe barium sulphate aspiration: a report of two cases and review of the literature

Katsanoulas, Constantine; Passakiotou, M.; Mouloudi, Eleni; Georgopoulou, Vasiliki; Gritsi-Gerogianni, N.

doi:10.22514/sv21.042007.6

Cited by 15 publications

(7 citation statements)

References 16 publications

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“…The titles and abstracts of all these articles were screened for their relevance to our study, and only 29 articles were selected for full-text reading. 1-29 A total of 129 articles were excluded as they were not related to barium sulfate aspiration, and the reasons for its exclusion are summarized in Figure 4. Of the selected 29 articles, 2 were duplicate.…”

Section: Resultsmentioning

confidence: 99%

“…However, severe hypoxia, ARDS, and even death can happen in selected cases and can usually be attributed to factors including but not limited to simultaneous aspiration of gastric contents, anaphylactic reaction, and high-volume aspiration. 2,8,9,12,19,24,26 …”

Section: Discussionmentioning

confidence: 99%

“…32-37 Second, in cases where contrast evaluation is necessary, some other lung-friendly contrast agents like iopydol, hytrast, and iodixanol can be considered. 12,19,38,39 Last, proper posturing and maneuvers, for example, rotating the head while lying on the side and chin touching the neck during barium swallow, can prevent aspiration of barium sulfate. 40 …”

Section: Discussionmentioning

confidence: 99%

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An Esophagogram or Tracheobronchogram? A Review of Barium Sulfate Aspiration

Hamid

Ullah

Rashid

et al. 2018

Journal of Investigative Medicine High Impact Case Reports

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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An Esophagogram or Tracheobronchogram? A Review of Barium Sulfate Aspiration

Hamid

Ullah

Rashid

et al. 2018

Journal of Investigative Medicine High Impact Case Reports

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“…Ba‐induced pulmonary reactions can be quantity‐dependent or vary depending on the volume of aspiration . Cases of incidental diagnosis of Ba aspiration have been reported in asymptomatic individuals long after the aspiration event . Therefore, small quantities of Ba may not have negative pulmonary consequences despite existence of the particles in the lung, either due to an initial weak immune response to Ba particles or the acquisition of immune tolerance.…”

Section: Discussionmentioning

confidence: 99%

Chronic inflammatory response in the rat lung to commonly used contrast agents for videofluoroscopy

Ueha

Nativ‐Zeltzer

Sato

et al. 2019

Laryngoscope Investig Oto

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Objectives Contrast agents (CAs) are essential for upper gastrointestinal and videofluoroscopic swallow studies (VFSSs). Recently, we reported that small amounts of Ba aspiration caused severe acute lung inflammation in a rodent model. However, the underlying molecular biological mechanisms of chronic response to CA aspiration remain unclear. The aims of this study were to explore the underlying molecular biological mechanisms of the chronic response to three kinds of CA aspiration on the lung. Study Design Animal model. Methods Eight‐week‐old male Sprague Dawley rats were divided into five groups (n = 6, each group). Three groups underwent tracheal instillation of one of three CAs: barium sulfate (Ba), ionic iodinated contrast agent (ICA), and nonionic iodinated contrast agent (NICA). A sham group was instilled with air and a control group was instilled with saline. All animals were euthanized 30 days after treatment and histological and gene analyses were performed. Results No animal died after CA or sham/control aspiration. Ba particles remained after 30 days and caused histopathologic changes and inflammatory cell infiltration. Iodinated ICA and NICA did not result in perceptible histologic change. Expression of Tnf, an inflammatory cytokine was increased in only Ba aspirated rats ( P = .0076). Other inflammatory cytokines and fibrosis‐related genes did not alter between groups. Conclusion Aspirated Ba particles did not clear from the lung within a month and caused mild chronic pulmonary inflammation. ICA and NICA did not cause any inflammatory responses in the lungs, suggesting that ICA and NICA may be safer CAs for VFSS than Ba. Level of Evidence NA

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“…When barium aspiration occurs, the volume aspirated has been reported to play an important role in the progression of aspiration [4]. When considerable amounts of barium sulphate are aspirated, leading to hypoxaemia, bronchoscopy as a therapeutic modality should be recommended to eliminate as much of the compound as possible [5].…”

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confidence: 99%

Accidental severe bronchial aspiration of barium uncovers diagnosis of bronchiectasis

Gerada

2013

Intern Emerg Med

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A 77-year-old man, with a history of chronic obstructive pulmonary disease (COPD) and radiotherapy-treated laryngeal malignancy diagnosed 15 years prior, presented with a 1-year history of intermittent dysphagia. As a part of his investigations, a barium swallow was obtained; but during the initial phases of the procedure, the patient aspirated the contrast agent of barium sulphate. A chest radiograph (Fig. 1a), taken few minutes after the aspiration, showed barium within the different segments and subsegments of the bronchial tree bilaterally, and uncovered features, such as irregular dilatation of the bronchial tree, non-tapering of the bronchi, luminal filling defects and lack of bronchial side branches, characteristic of bronchiectasis. This incident precipitated an exacerbation of COPD with type II respiratory failure, requiring bronchodilators, intravenous antibiotics and non-invasive ventilation using a bilevel positive airway pressure machine. On recovery, direct laryngoscopy revealed post-radiotherapy changes but no evidence of tumour recurrence. A speech and language pathology assessment using a few millilitres of water revealed weak laryngeal elevation, and immediate aspiration of water on swallowing. Given the high risk of further aspirations, advice regarding the benefits and risks of nasogastric tube insertion or percutaneous endoscopic gastrostomy tube insertion were given to the patient, but he declined both procedures. Six months following discharge, he was readmitted with an episode of food aspiration. A chest radiograph (Fig. 1b) revealed residual barium in both lung bases. This event precipitated another exacerbation of the COPD and bronchiectasis, which caused the patient to succumb to the disease.As early as the 1920s, the concept of utilizing contrast agents to aid in the diagnosis of pulmonary diseases, in particular bronchiectasis, had transpired. This involved instilling the contrast medium within the bronchial tree, by means of a catheter introduced in the trachea, and followed by the acquisition of various radiographs; a procedure known as bronchography. The initial contrast agents that were used in this regard were mainly water-and oil-based solutions. Subsequently in 1950s, barium sulphate, an inert and non-toxic agent, became a popular bronchographic medium that produced similar images as the earlier contrast agents, until the mid-1970s, when computed tomography became the gold standard imaging study for the investigation of pulmonary diseases.Although the earlier contrast agents, as well as barium sulphate, were considered safe bronchographic media, reports of pneumonitis and even death had been described with both [1]. The instilled contrast agent was found to cause obstruction of the small bronchi, followed by atelectasis of lung tissue and pneumonitis [2]. COPD patients often developed exacerbations after such procedures, as seen in our case. To minimize these risks, after the acquisition of the radiographs, patients were asked to cough and expectorate as much contrast dye as p...

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Severe barium sulphate aspiration: a report of two cases and review of the literature

Abstract: Patient 1A 43-year old male patient with a long history of schizoid personality disorder, suffering from dysphagia, underwent a radiographic contrast study with barium sulphate. The patient aspirated a large amount of the radiographic

Cited by 15 publications

References 16 publications

An Esophagogram or Tracheobronchogram? A Review of Barium Sulfate Aspiration

An Esophagogram or Tracheobronchogram? A Review of Barium Sulfate Aspiration

Chronic inflammatory response in the rat lung to commonly used contrast agents for videofluoroscopy

Accidental severe bronchial aspiration of barium uncovers diagnosis of bronchiectasis

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