Fatal aspiration of barium sulfate

Excerpt

Five weeks after a laparoscopic cholecystectomy an obese 64-year-old woman swallowed 100 ml of barium sulfate as part of a diagnostic radiographic contrast medium examination for a suspected invasive gastric carcinoma. After drinking the medium, she suddenly started vomiting while lying supine with resultant aspiration and minimal coughing. She was transferred to the Intensive Care Unit (5 h later). Chest X-rays showed bilateral alveolar opacities, predominantly on the right (Fig. 1) and bronchoscopy revealed white foamy barium residue in both lungs. Due to increasing dyspnea, she underwent endotracheal intubation with controlled artificial respiration. Subsequent radiographs showed bilateral aspiration pneumonia. Her clinical course was marked by adult respiratory distress syndrome (ARDS) with death 35 h after the event due to respiratory insufficiency from aspiration of barium sulfate complicated by aspiration pneumonia. A medicolegal autopsy confirmed the clinical findings with extensive pneumonia caused by contrast medium aspiration, particularly of the right lung, and a malignant gastric neoplasm with wide-spread lymphatic node metastases. Histology of the lungs showed polarizing rhomboid crystalline accumulations within the alveolar spaces with granulocytic infiltration, and hyaline membrane formation. Macrophages had also incorporated barium sulfate particles (Fig. 2).

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