Barium aspiration.

[sue13130]

My father, age 82, had an upper GI performed about a month ago.  During the procedure the tech. kept telling him to hurry up and my father ended up aspirating barium.  Since that time he has had increased difficulty with breathing and is weak.  He has been hospitalized once and received IV antibiotics since this happened for a 'possible' pneumonia/infiltrate.  He has had both a chest x-ray and CT scan.  He was discharged home one week ago and has an appointment with a pulmologist this coming Monday, February 23.  I realize the barium is not going away.  I will be going with my father to his appointment and want to know ahead of time what some of the options are for possibly removing the barium?  I hope they can do something, because he is so weak and out of breath that he is miserable.  He has Type II diabetes and is slightly anemic.  The reason he was having the upper GI performed was because he had been coughing and 'choking' as if something were in his throat, although these episodes were occasional. His results from the upper GI were negative.

Any information about how to possibly remove the barium from his lungs (both lower lobes) would be greatly appreciated.  I just want to have an idea of what might be said at his appointment on Monday.

Thanks,
Sue

[National Jewish]

Barium is relatively non-irritating.  However it can cause problems just by occupying air space, especially in an 82 year old.  Since barium is so heavy it should drain out of the lungs quickly.

The pulmonologist may recommend postural drainage and clapping.  This technique uses gravity to promote drainage from the lungs.  It may help remove the barium from your father’s lungs.

I would not attempt to remove the barium with an invasive procedure, except as a last resort.  If this is necessary, it could be done by bronchoscopy.  However it would probably be best to have an anesthesiologist intubate your father.  Then under mild sedation and perhaps under fluoroscopic guidance, the barium could be suctioned out with a large bore suction catheter.  The catheter could be passed straight into the right lower lobe.  To reach the left lower lobe the catheter may need to be positionally manipulated using a guide wire.

Since your father aspirated the barium, it is possible that his occasional episodes of coughing and choking are due to an ongoing swallowing problem.  If his vocal cords and/or windpipe are not closing properly when he swallows he could be aspirating.  When this happens some of what he is swallowing will get into his windpipe and lungs.  The pulmonologist may suggest further testing to see if aspiration is a problem for him.  A gastroenterologist would be the type of specialist to test and treat him for a swallowing problem.

[abdullah]

i agree with the concept that your father is likely aspirating and that would explain the chronic cough, and damage to lungs. there is no single procedure will remove the barium, and it will show up in x-rays for long period. i think looking for the aspiration episodes is warranted more attention to know if thiis is due to structural causes or neurological causes.

[SALT1209]

A related discussion, What are the risks associated with potential aspiration of barium during a videofluoroscopy? was started.