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Barium aspiration

Last revised by Mohammad Taghi Niknejad on 14 Mar 2024

Barium aspiration occurs occasionally during upper GI fluoroscopic studies using barium sulfate contrast, and usually only small amounts pass into the airways.

When only tiny quantities of barium pass into the airways (so-called microaspiration) the patient may remain asymptomatic. The only evidence that it has occurred being visible passage of a small quantity of radiopaque barium into the larynx (laryngeal penetration) or trachea (tracheal aspiration) on the fluoroscopic image. 

However some patients are symptomatic following small volume aspiration, and this is more likely as the volume of contrast medium aspirated increases and the presentation may include:

  • fever
  • coughing
  • dyspnea
  • hypoxia

In severe cases, acute respiratory distress syndrome (ARDS) may occur, and several deaths have been reported despite aggressive ventilatory management 1

Initial appearances on plain radiography, fluoroscopy and CT, will be similar with evidence of barium coating the larynx and tracheobronchial tree. Indeed it may bear a striking resemblance to an old-fashioned contrast bronchogram.

In the largest case review published, out of 22 adults that aspirated barium, eight died 1. It is likely that the mortality rate of barium aspiration is overstated in the literature with, presumably, many cases of mild aspiration not published.

Physiotherapy remains the only treatment recommended.

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