Mediastinitis secondary to barium leakage
Oesophageal stricture due to caustic ingestion. Treatment with mechanical dilatation many years ago resulted in oesophageal perforation for which barium swallow study was performed.
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Radio-opaque material representing leaked barium is seen in the mediastinum and right pleural space. Pleura is thickened presumably due to aseptic inflammation caused by leaked barium.
Suspected compromise of GI tract wall integrity is a strong contraindication for barium study. In this setting a non-ionic water-soluble contrast media is the best option.