Barium Aspiration

This is an x-ray of a 79 yo man who had lost weight and was being evaluated for swallowing difficulties.  During the process of having him rapidly swallow barium (dense element that allows one to visualize structures), he aspirated the barium into his lungs.  This led to respiratory failure.

Image from NEJM (link)

The x-ray showed barium into both right and left main stem bronchi in the left upper and lower lobes.  The barium spread to the smaller airways which produced the tree-in-bud appearance (arrow).

This patient had the barium suctioned out (as much as possible), but he developed shock, his heart stopped beating and he suffered severe brain injury.  He died a short time later.

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