A 79-year-old man was evaluated for unintentional weight loss and dysphagia. He underwent a modified barium swallow. During the rapid-drinking phase, the patient aspirated a large amount of barium (which did not elicit a cough reflex), which resulted in hypoxemic respiratory failure and subsequent intubation. He was admitted to the intensive care unit, and a chest film was obtained. The film showed barium in both the right and left main stem bronchi, outlining the bronchus intermedius, all four lower-lobe basal bronchi, and the segmental bronchi in the left upper and lower lobes. The barium also spread into the smaller airways, producing a tree-in-bud appearance (arrow). The patient underwent bronchoscopy, which confirmed the presence of barium in the right and left lower lobes and lingula. The barium was suctioned extensively. Circulatory shock developed, and the patient had severe anoxic brain injury after cardiac arrest. Despite fluid resuscitation and treatment with inotropic agents and antibiotics, his clinical condition deteriorated, and his family opted for conservative care. He died shortly thereafter.
It wasn't a barium swallow. It was a Modified Barium Swallow which assesses the oral and pharyngeal phase of the swallow. It is the standard for determining the severity of dysphagia. It is typically performed with a radiologist and Speech-Language Pathologist. The SLP will then determine the safest diet/liquid consistency, any compensatory strategies that may help protect the airway, and whst types of exercises will help improve swallowing function. This type of physical response is extremely rare; in 30 years of being an SLP I have never seen this happen.
I was kind of thinking the same thing…like…why have the patient swallow barium when you can inject it? What was the purpose in the swallow? We’re you specifically looking for something in the stomach? Or intestines?
Barium swallow is a common test to see if the patient is aspirating. You can inject it but it would not show if it was in the lungs or not that way. Typically it is not the first test though. Usually they start with a swallow evaluation by a speech therapist.
