Case Report: Two-year consequences of barium sulfate aspiration

Abstract

Aspiration of barium sulfate is a rare but recognized complication of upper gastrointestinal contrast studies. While the acute clinical manifestations have been widely reported, information on the long-term radiographic course and systemic absorption of retained pulmonary barium is scarce. We describe an 88-year-old man with chronic oropharyngeal dysphagia related to previous ischemic stroke and dementia who aspirated a high-density barium sulfate suspension (250% w/v) during an upper gastrointestinal study. He developed dyspnea, hypoxemia (lowest oxygen saturation 91%), and chemical pneumonitis, but recovered with supportive treatment. Serial chest radiographs showed gradual clearance of the aspirated barium, although residual pulmonary deposits remained visible two years later. At the two-year follow-up, the plasma barium concentration was <0.5 μg/L, whereas the urine barium concentration was 13.6 μg/L. These findings suggest that retained pulmonary barium may persist radiographically for years with little evidence of substantial systemic absorption. This case provides long-term radiographic follow-up together with biomonitoring data after barium sulfate aspiration, a combination that has rarely been reported.