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Barium sulphate aspiration
Clinical Picture
Barium sulphate aspiration Lancet 2004; 364: 2220 Department of Respiratory Medicine (K Kaira MD, A Takise MD, T Goto MD, T Horie MD), Maebashi Red Cross Hospital, 3-21-36, Asahi-cho, and First Department of Internal Medicine (M Mori MD), Gunma University, Shouwa-machi, Maebashi, Gunma 371-8511, Japan Correspondence to: Dr Kyoichi Kaira [email protected]
2220
Kyoichi Kaira, Atsushi Takise ,Tomoki Goto, Takeo Horie, Masatomo Mori
An asymptomatic 70-year-old man had a barium swallow to screen for gastric cancer. During the examination, the patient aspirated high-density barium contrast medium (200% weight/volume) into his lungs. After 1 h, the patient developed fever, so doctors gave him faropenem 600 mg orally. Chest radiographs showed massive barium sulphate depositions in both lower lobes, middle lobe, and lingula (figure). 48 h later, he became dyspnoeic with worsening hypoxaemia (PaO2 57·2 mm Hg, PaCO2 32·1 mm Hg, breathing room air), and was transferred to our hospital. We treated him with intravenous meropenem 1 g/day and clindamycin 1200 mg/day, physical therapy with postural drainage, and oxygen. He recovered, and was discharged 7 days later. Aspiration of large amounts of barium sulphate is a rare incident during radiographic contrast procedures. In spite of the inert character of barium sulphate, the aspiration of highdensity barium is potentially life-threatening.
www.thelancet.com Vol 364 December 18/25, 2004
Barium sulphate aspiration Lancet 2004; 364: 2220 Department of Respiratory Medicine (K Kaira MD, A Takise MD, T Goto MD, T Horie MD), Maebashi Red Cross Hospital, 3-21-36, Asahi-cho, and First Department of Internal Medicine (M Mori MD), Gunma University, Shouwa-machi, Maebashi, Gunma 371-8511, Japan Correspondence to: Dr Kyoichi Kaira [email protected]
2220
Kyoichi Kaira, Atsushi Takise ,Tomoki Goto, Takeo Horie, Masatomo Mori
An asymptomatic 70-year-old man had a barium swallow to screen for gastric cancer. During the examination, the patient aspirated high-density barium contrast medium (200% weight/volume) into his lungs. After 1 h, the patient developed fever, so doctors gave him faropenem 600 mg orally. Chest radiographs showed massive barium sulphate depositions in both lower lobes, middle lobe, and lingula (figure). 48 h later, he became dyspnoeic with worsening hypoxaemia (PaO2 57·2 mm Hg, PaCO2 32·1 mm Hg, breathing room air), and was transferred to our hospital. We treated him with intravenous meropenem 1 g/day and clindamycin 1200 mg/day, physical therapy with postural drainage, and oxygen. He recovered, and was discharged 7 days later. Aspiration of large amounts of barium sulphate is a rare incident during radiographic contrast procedures. In spite of the inert character of barium sulphate, the aspiration of highdensity barium is potentially life-threatening.
www.thelancet.com Vol 364 December 18/25, 2004