Severe complications following a "barium swallow" investigation for dysphagia.
OBJECTIVE
To highlight the risks of investigation of patients with swallowing disorders by "barium swallow", when the disorders may arise from dysfunction of the upper swallowing tract.


METHODS
An 81-year-old Italian woman presented to her local doctor with a history of dysphagia of five days' duration. A barium swallow resulted in aspiration of a large amount of barium into the right main bronchus, causing severe problems. After a period of intensive respiratory care including intubation and continuous positive airway pressure, she recovered sufficiently to be referred to a rehabilitation unit. She had mild hemiplegia but severe dysphagia, secondary to a brain stem infarct.


RESULTS
Persisting severe dysphagia was confirmed, with extreme risk of aspiration. The patient underwent percutaneous endoscopic gastrostomy and was discharged to live independently, but requiring long-term gastrostomy feeding.


CONCLUSIONS
When a patient presents with dysphagia, great care should be taken to exclude upper tract dysfunction with its attendant risk of aspiration, generally by referral to a centre or consultant with expertise in this area, before ordering or carrying out investigations appropriate to disorders of the lower tract.
Penington
G R
GR
North West Hospital, Melbourne, Vic.
D000368:Aged; D000369:Aged, 80 and over; D001464:Barium / Q000009:adverse effects*; D003679:Deglutition; D003680:Deglutition Disorders / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D005774:Gastrostomy; D006801:Humans; D001239:Inhalation; D011859:Radiography
D001464:Barium