This is an x-ray of a 79 yo man who had lost weight and was being evaluated for swallowing difficulties. During the process of having him rapidly swallow barium (dense element that allows one to visualize structures), he aspirated the barium into his lungs. This led to respiratory failure.
The x-ray showed barium into both right and left main stem bronchi in the left upper and lower lobes. The barium spread to the smaller airways which produced the tree-in-bud appearance (arrow).
This patient had the barium suctioned out (as much as possible), but he developed shock, his heart stopped beating and he suffered severe brain injury. He died a short time later.
Whilst barium studies are on the decrease these days, I think it emphasises the point very clearly that physicians shouldn’t request examinations so frequently as they do.
Whilst the complications and morbidity rates are generally quite low with radiological examinations, when they do go wrong the outcome is usually catastrophic.
Irradiating and putting substances into a patient should be the very last thing, not the first thing one tries.
What if he was my patient?