Barium sulfate aspiration: Severe chemical pneumonia induced by a massive reflux of contrast medium during small bowel barium enema

Zhang, Lin; Yang, Yi; Zhang, Ji; Zhou, Xiaowei; Dong, Hongmei; Zhou, Yiwu

doi:10.1016/j.forsciint.2015.05.016

Cited by 14 publications

(13 citation statements)

References 23 publications

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“…Pulmonary complications including infiltration of inflammatory cells, pulmonary edema, pneumonitis, and fibrosis due to CA aspiration have been reported . The underlying molecular biological mechanisms of acute responses to CA aspiration in the lungs have not been well examined.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, detailed investigations of chronic stages following Ba aspiration are necessary to gain a further understanding of whether deposited Ba particles are cleared and to elucidate the possible influences of BA deposits on pulmonary tissue. Serious complications and several deaths have been reported due to Ba aspiration in humans . The determination of the safest CA for use should be based on short‐ and long‐term advantages with regards to radiographic opacity, water solubility and osmolality, viscosity, and pulmonary toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…Since these initial reports, investigations regarding the pulmonary effects of CA aspiration have described conflicting findings. Aspiration of Ba sulfate, the most widely used CA, has been reported as having no negative effects on the respiratory system, whereas other studies described its severe toxicity and adverse effects on the respiratory organs . Moreover, only a few studies demonstrated the acute inflammation and histological changes in the lung following aspiration of NICAs and ICAs in animal studies, but clinical effects have not been shown.…”

Section: Introductionmentioning

confidence: 99%

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Acute inflammatory response to contrast agent aspiration and its mechanisms in the rat lung

et al. 2018

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Objectives/Hypothesis Contrast agent (CA) aspiration is an established complication of upper gastrointestinal and videofluoroscopic swallow studies. The underlying molecular biological mechanisms of acute response to CA aspiration in the respiratory organs remain unclear. The aims of this study were to elucidate the histological and biological influences of three kinds of CAs on the lung and to clarify the differences in acute responses. Study Design Animal model. Methods Eight‐week‐old male Sprague Dawley rats were divided into five groups (n = 6 in each group). Three groups underwent tracheal instillation of one of three different CAs: barium (Ba) sulfate, nonionic contrast agents (NICAs), and ionic contrast agents (ICAs). A control group was instilled with saline and a sham group was instilled with air. All animals were euthanized on day 2 after treatment and histological and gene analysis was performed. Results No animal died after CA or control/sham aspiration. Ba caused severe histopathologic changes and more prominent inflammatory cell infiltration in the lungs compared with the two other iodinated contrast agents. Increases in expressions of inflammatory cytokines (tumor necrosis factor [Tnf], interleukin‐1β [Il1b], and interferon‐γ [Ifng]) were observed in Ba aspiration rats, and upregulation of Il1b was seen in ICA aspiration rats. NICA did not cause obvious histologic changes or expressions of inflammatory cytokines and fibrosis‐related genes in the lungs. Conclusions Ba caused significantly more acute lung inflammation in a rodent model than did ioinic and nonionic iodinated CAs. Nonionic contrast did not cause any discernible inflammatory response in the lungs, suggesting that it may be the safest contrast for videofluoroscopic swallow studies. Level of Evidence NA Laryngoscope, 129:1533–1538, 2019

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute inflammatory response to contrast agent aspiration and its mechanisms in the rat lung

et al. 2018

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“…The evaluation of dysphagia in IIM patients has usually been made with esophageal barium x‐ray, but the risk of aspirating the barium sulfate limits the use of the x‐ray in patients with severe swallowing problems for a high risk of aspiration pneumonia and fatal outcome …”

Section: Discussionmentioning

confidence: 99%

Assessment of swallowing function with oro‐pharyngeal‐esophageal scintigraphy in patients with idiopathic inflammatory myopathies

Barsotti

Puccini²,

Tripoli

et al. 2019

Neurogastroenterology Motil

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Background: Swallowing impairment is frequently present in patients with idiopathic inflammatory myopathies (IIMs), and it represents an important cause of morbidity, dramatically reducing the quality of life of patients. Moreover, dysphagia is associated to a worst prognosis. Unfortunately, no standardized instrumental techniques for the assessment of the upper gastrointestinal tract in IIM patients are available. In this study, we explored the characteristics of the alterations in the upper gastrointestinal tract using oro-pharyngeal-esophageal scintigraphy (OPES) in a cohort of IIM patients and we correlated the alterations with clinical parameters. Methods: A total of 51 IIM patients were examined with OPES, both with liquids and semisolids, and the data acquired were examined to compute the transit time and the percentage of retention at oral, pharyngeal, and esophageal level. Patient-reported outcome data (PRO) on dysphagia, disease activity, and clinical parameters were collected.Key results: Oro-pharyngeal-esophageal scintigraphy identified at least one alteration in all patients, particularly with the semisolid test and oral and pharyngeal levels presented a higher frequency of involvement compared to the esophageal tract (P < 0.05). A very good correlation between dysphagia severity assessed by PRO and many OPES results was identified. In patients with a shorter disease duration, there was a higher prevalence of alterations at the oral and pharyngeal level and they were correlated to higher swallowing difficulties and higher disease activity parameters. Conclusions & inferences:Our results showed that OPES may represent a novel reproducible tool to assess dysphagia in IIM patients, thus opening new possibilities to evaluate dysphagia in these patients. K E Y W O R D Sdeglutition, disease activity, dysphagia, idiopathic inflammatory myopathies, scintigraphy

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“…A slight amount of barium aspiration may cause no symptomatic effects. While large amounts of barium in the lungs may interfere with gas exchange leading to a shunt effect and an altered ventilation/perfusion ratio [2,3]. Furthermore, barium could provoke a local reaction in lung parenchyma and lead to neutrophil infiltrates in the alveolar spaces, which makes it a potentially life-threatening event because of its direct harmful effects on lung tissue [4].…”

mentioning

confidence: 99%

The application of barium oesophagography in patients with suspected tracheo-oesophageal fistula: preferred or avoided?

Lü

Han

et al. 2021

Eur Respir Rev

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Barium sulfate aspiration: Severe chemical pneumonia induced by a massive reflux of contrast medium during small bowel barium enema

Cited by 14 publications

References 23 publications

Acute inflammatory response to contrast agent aspiration and its mechanisms in the rat lung

Acute inflammatory response to contrast agent aspiration and its mechanisms in the rat lung

Assessment of swallowing function with oro‐pharyngeal‐esophageal scintigraphy in patients with idiopathic inflammatory myopathies

The application of barium oesophagography in patients with suspected tracheo-oesophageal fistula: preferred or avoided?

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