Barium bronchogram from aspiration

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Swallowing difficulties. Barium swallow several days ago.

Patient Data

Age: 55 years
Gender: Female

Tracheostomy.

Large volume of barium aspiration in the left lower lobe giving a bronchogram of the lobar anatomy.

Background lungs hyperinflated.

Case Discussion

An impressive illustration of the bronchial anatomy of the left lower lobe to at least the subsegmental level.

Couple of practical practising points with barium swallows:

1. Ask the patient when they drink does it ever go down the wrong way'?

2. If in any doubt do a test swallow/sip with water-soluble contrast 

3. If they do aspirate ensure the patient gets immediate chest physiotherapy.

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