Aspiration of barium into the lungs is a recognized complication, occurring accidentally during upper gastrointestinal studies. Predisposing factors for aspiration are anatomical irregularities of pharynx and esophagus, diseases compromising the swallow mechanism, extremes of age, and alcoholism.1 Barium sulfate was thought to be relatively harmless in the airways, but this was based on the use of low-density suspensions, suggesting that the degree of pulmonary reaction may be proportional to the heterogeneity of the barium particles. However, complications have been reported with high- or low-density formulations.1 A rapid diagnosis in the acute phase is made with a simple chest radiograph that characteristically shows striking airway opacities without a specific pattern.2 Treatment options are based on clinical experience and are mainly based on supportive measures. When a considerable amount of barium is aspirated, immediate bronchoscopy is recommended with the purpose of eliminating as much barium as possible. Bronchoalveolar lavage is contraindicated because it can expand barium distribution into the airway. The overall mortality rate associated is approximately 30% and exceeds 50% in patients with initial shock or apnea, secondary pneumonia or adult respiratory distress syndrome.
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