Correspondence

Aspiration of Barium

N Engl J Med 2003; 348:2582-2583June 19, 2003

Article

To the Editor:

It seems unjustified to refer to a radiographic study using barium sulfate suspension as “A Deadly Examination,” as Fruchter and Dragu do (March 13 issue).1 The patient in this case may have died because of the aspiration of gastric contents, which only incidentally contained barium sulfate in suspension. The harmful effects of aspiration of gastric contents are well known and include the effects of acid, enzymes, and organic foreign material, as well as mechanical interference with gas exchange. Barium sulfate suspension, on the other hand, has been used for bronchography in the past.

James Whiting, M.D.
Portland Veterans Affairs Medical Center, Portland, OR 97207
whiting.james@med.va.gov

1 References

1. 1

   Fruchter O, Dragu R. A deadly examination. N Engl J Med 2003;348:1016-1016
   Full Text | Web of Science | Medline

Author/Editor Response

Although the aspiration of barium sulfate into the bronchial tree was once thought to be harmless, this assumption was based on the fact that low-density barium suspensions were used for bronchography.1 Moreover, serious consequences and even several deaths have been reported after the aspiration of either low-density or high-density barium by patients in all age groups, ranging from a two-month-old boy2 to elderly patients.1,3 There have been a number of experimental studies in animals in which barium has been shown to provoke a severe local reaction in the lung parenchyma. For example, in rats, barium caused a severe pulmonary inflammatory reaction.4 Furthermore, postmortem studies in two elderly women who died soon after the aspiration of barium demonstrated an intense acute inflammatory reaction characterized by neutrophil infiltrates in the alveolar spaces.5 Although one cannot rule out aspiration of gastric contents as a contributing cause of death in our patient, our aim was to stress that the aspiration of barium is potentially life-threatening because of its direct harmful effects on lung tissue.

Oren Fruchter, M.D.
National Institutes of Health, Bethesda, MD 20892-1583
fruchteo@mail.nih.gov

5 References

1. 1

   Tamm I, Kortsik C. Severe barium sulfate aspiration into the lung: clinical presentation, prognosis and therapy. Respiration 1999;66:81-84
   CrossRef | Web of Science | Medline

2. 2

   Lopez-Castilla JD, Cano M, Munoz M, et al. Massive bronchoalveolar aspiration of barium sulfate during a radiologic study of the upper digestive tract. Pediatr Pulmonol 1997;24:126-127
   Web of Science | Medline

3. 3

   Pracy JP, Montgomery PQ, Reading N. Acute pneumonitis caused by low density barium sulphate aspiration. J Laryngol Otol 1993;107:347-348
   CrossRef | Web of Science | Medline

4. 4

   Ginai AZ, ten Kate FJ, ten Berg RG, Hoornstra K. Experimental evaluation of various available contrast agents for use in the upper gastrointestinal tract in case of suspected leakage: effects on lungs. Br J Radiol 1984;57:895-901
   CrossRef | Web of Science | Medline

5. 5

   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
   CrossRef | Web of Science | Medline

Citing Articles (3)

Citing Articles

1. 1

   C. Buschmann, F. Schulz, M. Tsokos. (2011) Fatal aspiration of barium sulfate. Forensic Science, Medicine, and Pathology 7:1, 63-64
   CrossRef

2. 2

   David C. Stanton, Douglas Seeger, Brian T. Robinson. (2007) Barium periostitis: An intraoral complication following barium swallow. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 103:5, e33-e37
   CrossRef

3. 3

   Wan-Yu Lin, Shih-Chuan Tsai, Guang-Uei Hung. (2005) FDG-PET Findings in Barium Aspiration. Clinical Nuclear Medicine 30:5, 331-332
   CrossRef