A Clinical and Radiographic Paradox in a Case of Barium Aspiration

Barium studies are essential to the diagnostic work-up, especially in dysphagia, heartburn (dyspepsia), or gastroesophageal reflux (GERD). The barium swallow test, or esophagram, is essential in investigating patients with abnormalities within the esophagus. The barium sulfate used is inert to the gastrointestinal tract and causes no harm. However, problems begin when the contrast agent enters the trachea and then into the lungs. The author herein presents a case of barium aspiration in a 60 years old Indian male being investigated for the cause of dysphagia. In this case, the paradox was the radiograph's contradictory features and the patient's clinical features. The large aspiration on the radiograph alerted the clinicians. However, the patient was relatively asymptomatic, and thus a clinical and radiographic paradox should always be kept in the minds of the treating physicians, especially post barium aspiration.