Received: 26 March 2002
Revised: 2 August 2002
Accepted: 16 August 2002
Published online: 12 October 2002
© Springer-Verlag 2002
Abstract Aspiration of barium sul-
fate occurs accidentally. Lung reac-
tion is usually mild in the early
phase due to inert character of the
substance and long-term reactions or
late toxicities are not expected. Little
if any fibrotic response is speculated.
We present a case with barium aspi-
ration, studied by high-resolution
computed tomography (HRCT)
1 year after the event, as late pulmo-
nary sequelae studied by CT have
not been described yet, to the best of
our knowledge. The HRCT revealed
thickened interlobular septa, sub-
pleural lines, subpleural cysts, and
centrilobular micronodules along
with barium particles in a subpleural
distribution. Those findings indicat-
ed that barium is capable of produc-
ing mild though silent clinically
fibrosis.
Keywords Barium sulfate ·
Pneumonia aspiration · HRCT ·
Fibrosis · Contrast media
Eur Radiol (2003) 13:2226–2229
DOI 10.1007/s00330-002-1687-5
CHEST
A. Voloudaki
N. Ergazakis
N. Gourtsoyiannis
Late changes in barium sulfate aspiration:
HRCT features
Introduction
Aspiration of barium sulfate into the lungs occurs acci-
dentally during upper gastrointestinal tract radiological
examinations using barium contrast medium. Certain
conditions, such as head and neck cancer, cerebrovascu-
lar accident, broncho-esophageal fistula, closed-head in-
jury, and progressive neurologic disease predispose to
aspiration [1]. Due to the inert character of the sub-
stance, lung reaction is mild in the early phase, but acute
inflammation or even death has been reported [2, 3, 4].
Severe fibrosis is not considered a long-term sequela;
however, mild fibrosis may be seen pathologically but
has never been described by imaging methods [5].
We present a case of a patient who had suffered from
barium aspiration with emphasis on high-resolution com-
puted tomography (HRCT) features, obtained 1 year af-
ter the incident. The HRCT features of barium aspiration
have not been described thus far, to our knowledge, and
the same stands for late changes of such an event.
Case report
A 73-year-old woman underwent an abdominal CT as outpatient
for staging of uterus carcinoma. High-density pulmonary foci
were seen in the upper slices. The patient denied any coexisting
pulmonary disease or previous event, and an extended thoracic
HRCT was obtained.
High-density discrete foci were noted, located in the basal seg-
ments of both lower lobes and to a lesser degree in the middle lobe
and lingula. They ranged in size from 1 to 4 mm, although a few
conglomerations up to 1 cm were also depicted. Their distribution
was predominately subpleural along the dorsal and mediastinal
pleural surfaces and centrilobular near the edges of small vessels.
Randomly distributed particles were also seen. In the same ana-
tomic regions thickened interlobular septa, subpleural lines, and
subpleural cysts up to 3 mm in diameter, considered indicative
of subtle fibrosis, were observed. Soft tissue density micronodules
up to 2 mm were seen intermixed with the high-density (mean
1431 HU, SD 563 HU) particles. Subpleural lines and cysts did
not change in selective scans obtained in prone position (Figs. 1,
2, 3).
After questing and studying the patient’s medical record, we
found out that there was a history of barium aspiration 1 year pre-
viously, which the patient confirmed afterwards. During a barium
swallowing study for further investigation of eructation, barium
aspiration had occurred. Concomitant submandibular and lateral
neck lymphadenopathy due to teeth inflammation had been pre-
sumed to be a possible predisposing factor for the accidental bari-
A. Voloudaki (
✉
) · N. Ergazakis
N. Gourtsoyiannis
Department of Radiology,
University Hospital of Heraklion,
71110 Crete, Greece
e-mail: voloudak@med.uoc.gr
Tel.: +30-81-0392541/2
Fax: +30-81-0542095