Massive aspiration of barium sulfate during an upper gastrointestinal examination in a child with dysphagia

Barium sulfate is an agent used widely as a contrast material for imaging studies of the gastrointestinal tract and is not inherently toxic to lung tissue. Aspiration of barium sulfate has been reported on rare occasions, but is more frequently seen in patients with underlying anatomical or neurological defects such as head and neck deformity, esophageal stricture, diverticulum or fistula. We report a previously healthy child suffered from massive aspiration of barium sulfate during the investigation of dysphagia due to an impacted foreign body in the esophagus. Massive aspiration of barium sulfate is potentially life-threatening because of mechanical interference with gas exchange. An obstruction of the esophagus should be considered in the differential diagnosis for children with acute dysphagia and barium contrast should be used with great care in such instance.