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Beware the wrong way! A report on gastrografin inhalation

Matteo Guarino1
,  
Franco Alfano1
,  
Edoardo Gambuti1
,  
Benedetta Perna1
,  
Roberto De Giorgio1

1 Department of Translational Medicine, University Hospital St. Anna, Via A. Moro 8, 44124, Cona, Ferrara, Italy

Address correspondence to:

Matteo Guarino

Department of Translational Medicine, Emergency Medicine Unit, St. Anna Hospital, Via A. Moro 8, 44124 Cona (FE),

Italy

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Article ID: 101262Z01MG2021

doi: 10.5348/101262Z01MG2021CR

How to cite this article

Guarino M, Alfano F, Gambuti E, Perna B, De Giorgio R. Beware the wrong way! A report on gastrografin inhalation. Int J Case Rep Images 2021;12:101262Z01MG2021.

ABSTRACT

No Abstract

Keywords: Aspiration, Gastrografin, Pneumonia

Case Report

An 83-year-old man was admitted to the Emergency Department of St. Anna University Hospital, Cona, Italy, after he had inhaled diatrizoate (gastrografin), a well-known hyperosmolar contrast agent, during an X-ray of the upper gastrointestinal tract. The family physician recommended the patient to take the test in order to demonstrate a possible hiatal hernia. While swallowing gastrografin he had an esophageal spasm (detected at fluoroscopy), which led to the inhalation of the contrast agent. After the episode, he was completely asymptomatic, eupnoeic, and with a good peripheral oxygen saturation. The physical examination was unremarkable. A chest X-ray of the lungs showed accumulation of the contrast agent in the distal bronchial tree (arrows in Figure 1A and Figure 1B), with the right part being more involved because of the straight orientation of the right bronchus.

Figure 1: (A) and (B) A chest X-ray of the lungs showed accumulation of the contrast agent in the distal bronchial tree (arrows showing all the parts of the lungs involved by aspiration), with the right part being more involved.

Discussion

Inhalation of water soluble contrast agent during radiologic tests is an unusual occurrence; however, the few reported cases showed that patients may develop bronchospasm or even pulmonary edema and aspiration pneumonia [1],[2],[3].

Conclusion

No clinical abnormalities or short-term complications were noted in the patient herein reported. However, a cautionary treatment with parenteral steroid and clarithromycin therapy was performed. The patient was discharged in good health in less than 48 hours from admission.

REFERENCE

1.

Bellasfar G, Duchène P, Le Mée J, Mouelhi M, Langonnet F. Pulmonary complications after gastrografin inhalation during radiographic control of esophageal anastomosis. [Article in French]. Ann Fr Anesth Reanim 1986;5(5):533–5. [CrossRef] [Pubmed] Back to citation no. 1  

2.

Friedman BI, Hartenberg MA, Mulroy JJ, Tong TK, Mickell JJ. Gastrografin aspiration in a 3 ¾-year-old girl. Pediatr Radiol 1986;16(6):506–7. [CrossRef] [Pubmed] Back to citation no. 1  

3.

Tuladhar R, Patole S, Whitehall J. Gastrografin aspiration in a neonate with tracheoesophageal fistula. J Paediatr Child Health 2000;36(1):94–5. [CrossRef] [Pubmed] Back to citation no. 1  

SUPPORTING INFORMATION

Acknowledgments

The authors thank Drs. Franco Guerzoni and Elena Forini, from the Statistical Service of St. Anna Hospital, Ferrara, Italy, for helpful assistance in data collection.

Author Contributions

Matteo Guarino - Conception of the work, Design of the work, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Franco Alfano - Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Edoardo Gambuti - Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Benedetta Perna - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Roberto De Giorgio - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Data Availability Statement

The corresponding author is the guarantor of submission.

Consent For Publication

Written informed consent was obtained from the patient for publication of this article.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Competing Interests

Authors declare no conflict of interest.

Copyright

© 2021 Matteo Guarino et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.