Fatal Aspiration of Barium Sulfate in a Case of Myasthenia Gravis: A Case Report and Review of Literature

Barium contrast radiography is a usual procedure performed for detecting lesions of the digestive tract using barium sulfate on X-ray irradiation. The aspiration of barium contrast is an uncommon but well-documented complication occurring accidentally during examinations of the upper gastrointestinal system using contrast media. Certain conditions that affect the anatomical and functional integrity of the oropharynx and esophagus can be predisposing factors. Barium is an inert material that can cause symptoms varying from an asymptomatic mechanical obstruction to severe respiratory distress that can result in death when aspirated. Sudden death due to aspiration of barium is rarely reported in the literature. We report a case of a 50-year-old female who suddenly developed difficulty in breathing, followed by loss of consciousness during barium swallow procedure due to aspiration of barium contrast. She could not be revived and died within a few minutes of the episode. The predisposing factor was the weakness of the muscles of deglutition due to myasthenia gravis. We also reviewed the literature available on cases resulting from the aspiration of barium sulfate during the barium study procedures. We considered the factors like the age, indications, the distribution of barium in the lungs, clinical presentation, the period of survival, and cause of death. We came across only four cases of death within 24 h following the aspiration of barium. This case report and review of literature emphasize the importance of consideration of predisposing factors before conducting barium contrast radiography and also the possibility of sudden death.