Fatal aspiration of thick barium

The authors report a case of fatal aspiration of thick barium during esophagography in a 75-year-old woman. Apparently the patient held much of the barium in her mouth and then aspirated it as she tried to swallow. The authors suggest that thick barium be avoided when fluoroscopy shows that the patient has difficulty in swallowing thin barium and that a suction machine equipped with a large-bore catheter be readily available during esophagography, particularly in the elderly or obtunded patient.