Severe Barium Sulfate Aspirationinto the Lung: Clinical Presentation, Prognosis and Therapy

Tamm, Ingo; Kortsik, C.

doi:10.1159/000029344

Cited by 53 publications

(73 citation statements)

References 11 publications

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“…Aspiration of large amount of low-density barium sulfate (100%, w/v) (comparing with 160%w/v) is potentially doi: 10.7243/2053-6739-5-2 life-threatening because of mechanical interference to gas exchange, accumulation of barium sulfate within alveolar spaces causes alveolar shunting and this ventilation leads to perfusion (V/Q) abnormalities [5]. The clinical findings of our case in the first few days which were accepted and treated as sepsis may depend on those distribution abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Acute and chronic changes in massive barium sulfate aspiration in an infant who subsequently was diagnosed with severe gastro-esophageal reflux

Gultekin¹,

Pekcan²,

Poyraz³

2017

Pulmonol Respir Res

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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 deficit. 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 reflux and under conservative and medical treatment, a possible fundoplication surgery is planning.

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Section: Discussionmentioning

confidence: 99%

Acute and chronic changes in massive barium sulfate aspiration in an infant who subsequently was diagnosed with severe gastro-esophageal reflux

Gultekin¹,

Pekcan²,

Poyraz³

2017

Pulmonol Respir Res

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“…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]. It also facilitates collection of aspirates for microbiological analysis [5]. Our patient survived the initial insult without the use of bronchoscopy, but because of barium retention and exacerbation of COPD, he did not have enough respiratory reserve to survive the second insult (food aspiration).…”

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confidence: 89%

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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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“…Aspiration of barium sulfate has been reported on rare occasions, but is more frequently seen in patients with underlying anatomical or neurological defects such as head and neck deformity, esophageal stricture, diverticulum or fistula [1]. It was known that low-density barium suspensions were used for bronchography for the diagnosis of bronchiectasis in the past [2]. Aspiration of barium sulfate is not expected to cause severe lung injury in the early phase, as in our case, due to its relatively nonirritant character.…”

Section: Descriptionmentioning

confidence: 99%

Physiological Approach to a Penile Venous Stripping Surgical Procedure for Patients with Erectile Dysfunction

Chen¹

2013

Transl Med

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Severe Barium Sulfate Aspirationinto the Lung: Clinical Presentation, Prognosis and Therapy

Cited by 53 publications

References 11 publications

Acute and chronic changes in massive barium sulfate aspiration in an infant who subsequently was diagnosed with severe gastro-esophageal reflux

Acute and chronic changes in massive barium sulfate aspiration in an infant who subsequently was diagnosed with severe gastro-esophageal reflux

Accidental severe bronchial aspiration of barium uncovers diagnosis of bronchiectasis

Physiological Approach to a Penile Venous Stripping Surgical Procedure for Patients with Erectile Dysfunction

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