Severe complications following a "barium swallow" investigation for dysphagia

Med J Aust. 1993 Dec;159(11-12):764-5.


Objective: To highlight the risks of investigation of patients with swallowing disorders by "barium swallow", when the disorders may arise from dysfunction of the upper swallowing tract.

Clinical features: An 81-year-old Italian woman presented to her local doctor with a history of dysphagia of five days' duration. A barium swallow resulted in aspiration of a large amount of barium into the right main bronchus, causing severe problems. After a period of intensive respiratory care including intubation and continuous positive airway pressure, she recovered sufficiently to be referred to a rehabilitation unit. She had mild hemiplegia but severe dysphagia, secondary to a brain stem infarct.

Intervention and outcome: Persisting severe dysphagia was confirmed, with extreme risk of aspiration. The patient underwent percutaneous endoscopic gastrostomy and was discharged to live independently, but requiring long-term gastrostomy feeding.

Conclusion: When a patient presents with dysphagia, great care should be taken to exclude upper tract dysfunction with its attendant risk of aspiration, generally by referral to a centre or consultant with expertise in this area, before ordering or carrying out investigations appropriate to disorders of the lower tract.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Aged, 80 and over
  • Barium / adverse effects*
  • Deglutition Disorders / diagnostic imaging
  • Deglutition Disorders / physiopathology*
  • Deglutition Disorders / therapy
  • Deglutition*
  • Female
  • Gastrostomy
  • Humans
  • Inhalation
  • Radiography


  • Barium