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Clinical Images  |   August 2019
Barium Contrast Aspiration
Author Notes
  • From the Department of Internal Medicine at the John H. Stroger, Jr. Hospital of Cook County in Chicago, Illinois. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to Parth Desai, DO, John H. Stroger, Jr. Hospital of Cook County, 1969 W Ogden Ave, Chicago IL, 60612-3765Email: parth.desai@cookcountyhhs.org
     
Article Information
Imaging / Pulmonary Disorders / Clinical Images
Clinical Images   |   August 2019
Barium Contrast Aspiration
The Journal of the American Osteopathic Association, August 2019, Vol. 119, 541. doi:https://doi.org/10.7556/jaoa.2019.097
The Journal of the American Osteopathic Association, August 2019, Vol. 119, 541. doi:https://doi.org/10.7556/jaoa.2019.097
An 82-year-old woman with type 2 diabetes mellitus was evaluated for aspiration pneumonia. She reported progressive dysphagia to solids and liquids for 4 years. Barium contrast esophagram was attempted; however, the patient aspirated a large volume of contrast medium (image A). She experienced acute hypoxic respiratory failure requiring intubation. Bronchoscopy was performed with aspiration of about 5 mL of contrast, and she was extubated without complication. Because of the high risk of aspiration events recurring, she elected for surgical gastronomy tube placement for enteral nutrition and remained in stable condition on follow-up after discharge. 
Barium sulfate aspiration is a rare cause of clinically significant pulmonary disease.1-3 Risk factors for barium contrast aspiration include advanced age,1-3 known oropharyngeal dysphagia,3 head and neck cancers,3 and vomiting.2 Management includes supportive care with oxygen and chest physiotherapy.2 Bronchoscopy with suction may be used with caution in severe cases; however, there is risk of seeding of contrast throughout the bronchial tree.1,2 
References
Gendeh HS, Hashim ND, Yunus MR, Gendeh BS, Kosai NR. The sequelae of barium aspiration. ANZ J Surg. 2016;88(9):937-938. doi: 10.1111/ans.13624 [CrossRef] [PubMed]
Jo H, Park J, Min D, et al.   Incidence of pneumonia after videofluoroscopic swallowing study and associated factors. Dysphagia. 2015;31(1):41-48. doi: 10.1007/s00455-015-9656-8
Hamid M, Ullah W, Rashid MU, Amjad W, Mukhtar M, Hurairah A. An esophagogram or tracheobronchogram? a review of barium sulfate aspiration. J Investig Med High Impact Case Rep. 2018;6:232470961880287. doi: 10.1177/2324709618802872 [CrossRef]