Barium embolism
Barium intravasation represents the feared - and fortunately very rare - complication of passage of barium sulfate contrast medium from the GI tract into the bloodstream.
Epidemiology
Entry of barium into the bloodstream, usually the venous circulation is very rare, and a paper published in 2005 stated that there were 36 reported cases in the literature in the previous 50 years . Of these cases, ~48% were fatal.
Clinical presentation
Clinical features invariably varies with the specific vessels into which the barium intravasates. Common features include:
- sudden deterioration within hours of completion of the contrast procedure
- at times during/within minutes of the procedure
- vasovagal syncope
- abdominal pain
- chest pain
Unfortunately, serious sequelae are not uncommon:
- hypovolemic shock
- disseminated intravascular coagulation (DIC)
- cardiac arrest
- death
Radiographic features
Often the first sign is barium visualization in the vessels during the procedure.
Treatment and prognosis
Clearly experience with what is the most successful treatment strategy is very limited in view of the rarity of this complication.
- immediately cease the procedure as soon as intravasation is suspected
- head up positioning of patient to reduce chance of barium entering the pulmonary circulation
- intensive monitoring +/- fluid resuscitation
