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Fatal barium embolization due to incorrect vaginal rather than colonic insertion. An ultrastructural and x-ray
Archives of Pathology & Laboratory Medicine
|October 1, 1983
Summary
Fatal barium sulfate (BaSO4) embolization occurred due to incorrect enema tip placement. Reticuloendothelial cells in organs accumulated BaSO4 granules, confirmed by X-ray microanalysis.
Area of Science:
- Pathology
- Medical Imaging
- Toxicology
Background:
- Barium sulfate (BaSO4) is commonly used as a radiocontrast agent for gastrointestinal imaging.
- Medical errors during procedures can lead to severe complications.
Observation:
- A case of fatal generalized barium sulfate embolization is presented, resulting from erroneous vaginal insertion of an enema tip intended for colon examination.
- Light microscopy revealed swollen, granular reticuloendothelial cells in multiple visceral organs, including the lung, liver, spleen, bone marrow, kidney, and brain.
Findings:
- Transmission electron microscopy demonstrated that these reticuloendothelial cells were laden with electron-dense BaSO4 granules of varying sizes.
- Scanning electron microscopy with energy-dispersive X-ray analysis confirmed the presence and elemental composition of BaSO4 within these granules in unstained paraffin-embedded tissue sections.
Implications:
- This case highlights the critical importance of correct procedure technique in medical imaging to prevent catastrophic complications.
- X-ray microanalysis is a valuable technique for the definitive identification of inorganic materials in human tissues, applicable to routine paraffin-embedded samples.