Unintentional Intravenous Injection of Barium Sulfate in a Child

Objective: Barium sulfate is relatively insoluble and intravasation into the portal system during barium enema may be tolerated, although barium deposits in the liver can be inflammatory and persist for years. Intravasation into the systemic circulation carries a worse * because of a high rate of mortality from massive pulmonary embolism (1). We report a * of barium sulfate injection directly into the superior vena cava during an upper * series (UGIS) to which the patient's central venous catheter (CVC) port was mistaken * her gastrostomy tube. Case report: A 17 month old girl was brought to the * suite for an UGIS with barium sulfate contrast. Her past medical history was significant for premature birth at 34 weeks gestation, short gut syndrome after bowel resection for necroting enterocolitis and gastroschesis, and multiple bouts of sepsis. She was admitted to * for replacement of her CVC but developed a diarrheal illness with multiple bouts of vomiting, and was therefore was scheduled for the UGIS. While to the fluoroscopy * approximately 3 mL of barium sulfate was injected into her CVC instead of her * tube. The error was recognized when radiography demonstrated barium fa the right * and 10 mL of blood containing a chalky white suspension was immediately aspirated * the catheter. The patient vomited three times, but then appeared well until 30 minutes * when she developed rigors. That evening she developed fever which was treated with a spectrum antibiotics. Subsequent radiographs failed to show residual barium, no signs of piratory distress developed, and she was discharged to stable condition four * later. Conclusion: Previous reports of barium intravasation into the systemic * have described a high mortality rate from massive pulmonary embolus. To our knowled this is the first report of direct injection of barium sulfate into the systemic venous * . We believe the patient survived because the error was immediately recognized, and * barium removed prior to embolism.