Barium aspiration in an infant: a case report and review of management

Unusual focal opacities in the lungs

[No Abstract Available].

The effects of barium concentration levels on the pulmonary inflammatory response in a rat model of aspiration

PURPOSE

Barium sulfate (Ba) suspension is the most widely used contrast agent for upper gastrointestinal and videofluoroscopic swallow studies (VFSS). The effect of Ba concentration on lung injury is uncertain. The aims of this study were to explore the effects of different barium concentrations on the respiratory organs and elucidate the underlying mechanisms of these effects in an established animal model of aspiration.

METHODS

Animal model study. Eight-week-old male Sprague-Dawley rats were allocated into three groups (n = 12, each group). Two groups underwent tracheal instillation of low (30% w/v) and high (60% w/v) concentration Ba (low-Ba, high-Ba). A control group was instilled with saline. Half of the animals were euthanized on day 2 and the remaining half were euthanized on day 30. Histological and gene analyses were performed.

RESULTS

Both low-Ba and high-Ba aspiration caused inflammatory cell infiltration in the lung at 2 days post aspiration with an increase in the expression of inflammatory cytokines. At 30 days post aspiration, small quantities of barium particles remained in the lung of the low-Ba group without any inflammatory reaction. Chronic inflammation was recognized in the high-Ba group up to 30 days post aspiration.

CONCLUSION

A small amount of high concentration Ba (60% w/v) caused sustained inflammation in the rat lung at least 30 days after aspiration. Even with a small amount of low concentration Ba aspiration (30% w/v), Ba particles can remain in the lung over a month, causing sustained late effects.

An Esophagogram or Tracheobronchogram? A Review of Barium Sulfate Aspiration

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 sulphate aspiration pneumonia in a cat with megaesophagus and dextroposition of the aortic arch: case report

ABSTRACT A six-month-old female cat suffered aspiration of an abundant amount of barium sulfate during a radiographic procedure for the diagnosis of megaesophagus. Latero-lateral contrast radiography revealed severe dilation of the thoracic esophagus cranial to the base of the heart. Persistence of the right aortic arch was suspected and later confirmed during corrective surgery. Accumulation of barium sulfate, used as a contrast agent, was clearly observed in the lumen of the bronchi, bronchioles, and alveoli in the radiographic image. Days after the surgery, the animal developed severe respiratory distress, which resulted in death. Cytology results and histology analysis using polarized light demonstrated that the lumen of bronchi, bronchioles, and alveoli exhibited evident histiocytic infiltration with cytoplasm filled by abundant amorphous refractive granular material consistent with barium sulfate. In this report, we describe the anatomical, cytological, histopathological (using polarized light), and x-ray findings of a case of barium sulfate aspiration pneumonia in a cat resulting from the use of this contrast medium for the diagnosis of megaesophagus secondary to persistent right aortic arch.

A case report and literature review of barium sulphate aspiration during upper gastrointestinal examination

RATIONALE

Even though barium sulphate aspiration during upper gastrointestinal examination is a well-known phenomenon, complication such as long-term lung injury and death may still occur. This may depend upon the concentration, amount, anatomy, or certain predisposing factors.

PATIENT CONCERNS

A 47-year-old woman who had a barium swallow to screen for foreign body in esophagus.

DIAGNOSES

Chest radiographs demonstrated massive barium sulphate depositions in her trachea and inferior lobe of right lung.

INTERVENTIONS

A chest x-ray was done that revealed massive barium sulphate depositions in her trachea and lower lobe of right lung. As the patient did not have further complaints, she requested a transfer to West China Hospital of Sichuan University, the hospital being near her residence, for further treatment. She eventually recovered and was discharged after 1 week.

OUTCOMES

There were 23 articles (22 English and 1 Chinese with 17 men and 11 women) included in the study. The risk factors of barium sulphate aspiration are dysphagia (10/28, 35.71%) followed by esophageal obstruction caused by tumor (5/28, 17.86%) and foreign body in esophagus (3/28, 10.71%). Infants (5/28, 17.86%) are also one of the high-risk population. Both the lungs were affected in most of the patients (21/28, 75%). Majority of the presentation in patients (21/28, 75%) were dyspnea, hypoxemia, acute respiratory distress syndrome (ARDS), or respiratory failure. Few patients (7/28, 25%) showed no symptoms or mild symptoms such as cough and fever. Barium sulphate aspiration can be life-threatening with a high risk of death (nearly 40%).

LESSONS

When performing an upper gastrointestinal examination with barium sulphate, careful consideration of concentration and amount of barium sulphate and that of risk factors should be undertaken so as to avoid life-threatening aspiration.