Department of Forensic Medicine, Shyam Shah Medical College, Rewa, Madhya Pradesh, India.
Department of Forensic Medicine, All India Institute of Medical Sciences, Jodhpur, India.
J Forensic Sci. 2020 Jul;65(4):1350-1353. doi: 10.1111/1556-4029.14297. Epub 2020 Feb 18.
Barium contrast radiography is a usual procedure performed for detecting lesions of the digestive tract using barium sulfate on X-ray irradiation. The aspiration of barium contrast is an uncommon but well-documented complication occurring accidentally during examinations of the upper gastrointestinal system using contrast media. Certain conditions that affect the anatomical and functional integrity of the oropharynx and esophagus can be predisposing factors. Barium is an inert material that can cause symptoms varying from an asymptomatic mechanical obstruction to severe respiratory distress that can result in death when aspirated. Sudden death due to aspiration of barium is rarely reported in the literature. We report a case of a 50-year-old female who suddenly developed difficulty in breathing, followed by loss of consciousness during barium swallow procedure due to aspiration of barium contrast. She could not be revived and died within a few minutes of the episode. The predisposing factor was the weakness of the muscles of deglutition due to myasthenia gravis. We also reviewed the literature available on cases resulting from the aspiration of barium sulfate during the barium study procedures. We considered the factors like the age, indications, the distribution of barium in the lungs, clinical presentation, the period of survival, and cause of death. We came across only four cases of death within 24 h following the aspiration of barium. This case report and review of literature emphasize the importance of consideration of predisposing factors before conducting barium contrast radiography and also the possibility of sudden death.
钡对比放射摄影是一种常用的程序，用于通过 X 射线照射使用硫酸钡检测消化道病变。钡对比剂的吸入是一种不常见但有充分记录的并发症，在使用对比剂对上消化道系统进行检查时意外发生。某些影响口咽和食管解剖和功能完整性的情况可能是诱发因素。钡是一种惰性物质，可引起从无症状的机械性梗阻到严重呼吸窘迫等症状，当吸入时可导致死亡。由于吸入钡而导致的突然死亡在文献中很少报道。我们报告了一例 50 岁女性的病例，她在钡吞咽过程中突然出现呼吸困难，随后意识丧失，原因是吸入钡对比剂。她无法复苏，并在发作后的几分钟内死亡。诱发因素是重症肌无力导致的吞咽肌肉无力。我们还回顾了文献中与钡研究过程中吸入硫酸钡有关的病例。我们考虑了年龄、适应证、钡在肺部的分布、临床表现、生存时间和死亡原因等因素。我们只发现了 4 例在吸入钡后 24 小时内死亡的病例。本病例报告和文献复习强调了在进行钡对比放射摄影前考虑诱发因素的重要性，以及突然死亡的可能性。
