Unexpected Barium Aspiration

A barium esophagram is a diagnostic test used for the evaluation of dysphagia. However, this test has the potential risk for aspiration of the barium contrast. Barium aspiration typically localizes to the right lower lobe or left lingular lobe. We present a case of barium aspiration localized to the right middle lobe that persisted on chest X-ray. A 62-year-old male with a past medical history of hypertension, long-term back pain, gastritis, and anxiety presented with the complaints of hoarseness of voice, dysphagia, and weight loss for several months. During the esophagram, the patient aspirated the barium contrast. Chest X-ray confirmed the aspiration in the right middle lobe with a tree in bud appearance suggesting involvement of bronchioles. Three months later, a repeat chest X-ray revealed residual contrast. Pulmonary complications are directly related to the amount of aspirated barium and can include hypoxia, respiratory failure, secondary aspiration pneumonia, shock, and acute respiration distress syndrome. The prognosis of a barium aspiration is dependent on the amount of barium aspirated.