title: Severe complications following a "barium swallow" investigation for dysphagia.
abstract: 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.
authors.affiliation: North West Hospital, Melbourne, Vic.
authors.forename: G R
authors.initials: GR
authors.lastname: Penington
mesh_terms: 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
chemical_list: D001464:Barium