Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
권호 표지
DOI QR코드

DOI QR Code

Massive barium sulfate aspiration during upper gastrointestinal contrast material study in an elderly patient with dysphagia

  • Yun, Hae Ryong (Division of Pulmonology, Department of Internal Medicine, The Institute of Chest Diseases, Yonsei University College of Medicine) ;
  • Kim, Chang-gon (Division of Pulmonology, Department of Internal Medicine, The Institute of Chest Diseases, Yonsei University College of Medicine) ;
  • Park, Jihye (Division of Pulmonology, Department of Internal Medicine, The Institute of Chest Diseases, Yonsei University College of Medicine) ;
  • Park, Yong eun (Division of Pulmonology, Department of Internal Medicine, The Institute of Chest Diseases, Yonsei University College of Medicine) ;
  • lee, Yong-il (Division of Pulmonology, Department of Internal Medicine, The Institute of Chest Diseases, Yonsei University College of Medicine) ;
  • Yoo, Byung-Woo (Division of Pulmonology, Department of Internal Medicine, The Institute of Chest Diseases, Yonsei University College of Medicine) ;
  • Chung, Kyung Soo (Division of Pulmonology, Department of Internal Medicine, The Institute of Chest Diseases, Yonsei University College of Medicine) ;
  • Kim, Young Sam (Division of Pulmonology, Department of Internal Medicine, The Institute of Chest Diseases, Yonsei University College of Medicine) ;
  • Song, Joo Han (Division of Pulmonology, Department of Internal Medicine, The Institute of Chest Diseases, Yonsei University College of Medicine)
  • Received : 2015.06.19
  • Accepted : 2015.08.11
  • Published : 2016.11.18
Download PDF
⟨ Previous Next ⟩

Abstract

Barium sulfate is an inert material used as a radiographic contrast medium during upper gastrointestinal contrast studies for evaluation of patients with dysphagia. Oral barium aspiration is an uncommon but well-reported complication of this procedure. While barium aspiration of small amounts may not cause any symptoms, massive barium aspiration can be life-threatening, particularly in elderly patients with multiple comorbidities. In this case report, we describe an elderly patient with multiple comorbidities who presented with thyrotoxicosis and dysphagia, and then died after massive barium aspiration. Despite administration of intensive medical care with ventilator support and therapeutic bronchoalveolar lavage to remove the aspirated barium, the patient died of multiple organ failure 9 days after barium aspiration. Clinicians should pay attention to elderly patients with predisposing factors for aspiration in whom upper gastrointestinal barium contrast studies are indicated, and should consider other diagnostic tools for evaluation of dysphagia in this population.

Keywords

References

  1. Pracy JP, Montgomery PQ, Reading N. Acute pneumonitis caused by low density barium sulphate aspiration. J Laryngol Otol 1993;107:347-8. https://doi.org/10.1017/S002221510012300X
  2. Franquet T, Gimenez A, Roson N, Torrubia S, Sabate JM, Perez C. Aspiration diseases: findings, pitfalls, and differential diagnosis. Radiographics 2000;20:673-85. https://doi.org/10.1148/radiographics.20.3.g00ma01673
  3. Cook IJ. Oropharyngeal dysphagia. Gastroenterol Clin North Am 2009;38:411-31. https://doi.org/10.1016/j.gtc.2009.06.003
  4. Ramsay ID. Muscle dysfunction in hyperthyroidism. Lancet 1966;2(7470):931-4.
  5. Chiu WY, Yang CC, Huang IC, Huang TS. Dysphagia as a manifestation of thyrotoxicosis: report of three cases and literature review. Dysphagia 2004;19:120-4.
  6. Boddu NJ, Badireddi S, Straub KD, Schwankhaus J, Jagana R. Acute thyrotoxic bulbar myopathy with encephalopathic behaviour: an uncommon complication of hyperthyroidism. Case Rep Endocrinol 2013;2013:369807.
  7. Okada H, Yoshioka K. Thyrotoxicosis complicated with dysphagia. Intern Med 2009;48:1243-5. https://doi.org/10.2169/internalmedicine.48.2202
  8. Teismann IK, Steinstraeter O, Schwindt W, Ringelstein EB, Pantev C, Dziewas R. Age-related changes in cortical swallowing processing. Neurobiol Aging 2010;31:1044-50. https://doi.org/10.1016/j.neurobiolaging.2008.07.001
  9. Kendall KA, Leonard RJ, McKenzie S. Common medical conditions in the elderly: impact on pharyngeal bolus transit. Dysphagia 2004;19:71-7.
  10. Roden DF, Altman KW. Causes of dysphagia among different age groups: a systematic review of the literature. Otolaryngol Clin North Am 2013;46:965-87. https://doi.org/10.1016/j.otc.2013.08.008
  11. Aslam M, Vaezi MF. Dysphagia in the elderly. Gastroenterol Hepatol (N Y) 2013;9:784-95.
  12. Willson JK, Rubin PS, McGee TM. The effects of barium sulfate on the lungs: a clinical and experimental study. Am J Roentgenol Radium Ther Nucl Med 1959;82:84-94.
  13. Nelson SW, Christoforidis A, Pratt PC. Barium sulfate and bismuth subcarbonate suspensions as bronchographic contrast media. Radiology 1959;72:829-38. https://doi.org/10.1148/72.6.829
  14. Shook CD, Felson B. Inhalation bronchography. Chest 1970;58:333-7. https://doi.org/10.1378/chest.58.4.333
  15. Voloudaki A, Ergazakis N, Gourtsoyiannis N. Late changes in barium sulfate aspiration: HRCT features. Eur Radiol 2003;13:2226-9. https://doi.org/10.1007/s00330-002-1687-5
  16. Jackson M, Kapur N, Goyal V, Choo K, Sarikwal A, Masters IB, et al. Barium aspiration in an infant: a case report and review of management. Front Pediatr 2014;2:37.
  17. Chiu CY, Wong KS, Tsai MH. Massive aspiration of barium sulfate during an upper gastrointestinal examination in a child with dysphagia. Int J Pediatr Otorhinolaryngol 2005;69:541-4. https://doi.org/10.1016/j.ijporl.2004.11.008
  18. Gray C, Sivaloganathan S, Simpkins KC. Aspiration of high-density barium contrast medium causing acute pulmonary inflammation--report of two fatal cases in elderly women with disordered swallowing. Clin Radiol 1989;40:397-400. https://doi.org/10.1016/S0009-9260(89)80135-7
  19. Fruchter O, Dragu R. Images in clinical medicine. A deadly examination. N Engl J Med 2003;348:1016. https://doi.org/10.1056/NEJMicm020803
  20. Rodriguez-Gutierrez R, Mendoza-Garcia A, Gonzalez-Saldivar G, Gonzalez-Gonzalez JG. Massive barium aspiration. Am J Med Sci 2014;348:249. https://doi.org/10.1097/MAJ.0b013e31827bfa3e