title: Barium sulfate aspiration: Severe chemical pneumonia induced by a massive reflux of contrast medium during small bowel barium enema.
abstract: Barium contrast radiography is a conventional procedure aimed at revealing lesions of the alimentary tract using barium sulfate on X-ray irradiation. Although it is widely used in clinics, adverse effects and complications are observed, such as anaphylaxis, granuloma, fecalithes, abdomen-leaking, embolism, bacterial contamination, and aspiration. We report a case of death due to a massive barium sulfate aspiration resulted from an air-barium double contrast enema radiography. A 25-year-old female patient was hospitalized with symptoms of abdominal distention, nausea, vomiting and diarrhea for three days. A progressive respiratory distress presented only 1h after a small bowel air-barium double contrast enema. The patient died 11h later. The result of autopsy revealed the cause of death to be severe chemical pneumonitis induced by gastric fluid which was aspirated into her lungs. Barium sulfate is generally recognized to be chemically inert for the respiratory system, but a mixture of barium sulfate with gastric contents is fatal. Here we intend to suggest that, when determining the potential cause of death, medical examiners should consider a patient's status quo as well as the possible adverse effects and complications caused by the barium sulfate preparation during gastrointestinal radiography.
authors.affiliation: Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China.
authors.forename: Lin
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China.
authors.forename: Ji
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China.
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Zhou
authors.affiliation: Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China. Electronic address: hongmeidong1@hotmail.com.
authors.forename: Hongmei
authors.initials: H
authors.lastname: Dong
authors.affiliation: Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, PR China. Electronic address: zhouyiwu@outlook.com.
authors.forename: Yiwu
authors.initials: Y
authors.lastname: Zhou
mesh_terms: D000328:Adult; D001466:Barium Sulfate / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects*; D004733:Enema; D017809:Fatal Outcome; D005260:Female; D005766:Gastrointestinal Contents / Q000737:chemistry; D006801:Humans; D008168:Lung / Q000473:pathology; D011015:Pneumonia, Aspiration / Q000139:chemically induced*; D053120:Respiratory Aspiration / Q000209:etiology*; D012128:Respiratory Distress Syndrome / Q000139:chemically induced
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate
keywords: Barium sulfate aspiration; Chemical pneumonia; Forensic pathology; Radiographic complication