Two cases of barium aspiration

—Evaluation of the temporal changes of the barium crystals in macrophages—

Abstract

Background : Barium contrast is commonly used for gastric cancer screening, and barium aspiration is a rare complication of the procedure. The temporal changes of barium crystals in the macrophages were evaluated and compared in two cases of barium aspiration by sampling carried out at different time-points.

Case : Case 1 : A 74-year-old woman underwent an upper gastrointestinal barium study. A chest X-ray taken immediately after the study revealed barium aspiration. She was immediately admitted to our hospital for bronchial lavage, and the bronchoalveolar lavage fluid (BALF) was sent for cytological testing.

Case 2 : A 69-year-old man underwent an upper gastrointestinal barium study. A chest X ray taken 15 days later revealed massive barium aspiration. BALF cytological testing and transbronchial lung biopsy (TBLB) were performed 24 days later.

Birefringent crystals were seen in the BALF in both cases. A higher number and volume of crystal-laden macrophages were seen in Case 2. With time, the crystals in the macrophages became smaller with the loss of their birefringence.

Conclusion : The accidentally aspirated barium crystals mostly remain within the interstitium and alveolar spaces for a long period, and only a small amount of barium is phagocytosed by macrophages.