Case Report: Two-year consequences of barium sulfate aspiration

Abstract

Aspiration of barium contrast is a rare, but well-known, event occurring during examinations of the upper gastrointestinal system using contrast media. We present a case of large-volume high-concentration barium sulfate aspiration in an 88-year-old male diagnosed with dysphagia, during the swallowing study. He rapidly developed difficulty in breathing, hypoxemia and chemical pneumonitis. The chest radiograph showed the infiltration of barium contrast at both sides with left lower lung predominance. His lowest oxygen saturation by pulse oximetry was 91%. His condition improved with supportive care including oxygen therapy. The patient was finally discharged a few days later with normal oxygen saturation by pulse oximetry. The follow-up chest radiograph at 2 years after the aspiration showed considerable interval clearing of the aspirated contrast material. The plasma and urine barium concentrations at 2 years after the aspiration were <0.5 μg/L and 13.6 μg/L, respectively. Currently, there is no reference urine barium level in the Thai population. These finding may be partially explained by our patient’s exposure of barium from food or water or might be gradually absorbed systemically from the residual barium in lungs.