Does A Barium Swallow Cause Lump In Throat And Rib Cage?

Posted on Fri, 24 Oct 2014

Question: I have a 75-y/o 108 lb family member who had a barium swallow (maybe a modified cookie test?) test today (she describes as a series of liquids followed by a cracker with barium). At 10:30 pm temp was 97.7. 3:30 a.m. 101.5. Unsteady on feet. Reported pain low in throat when swallowed and where ribs meet at bottom of rib cage when she took the cracker part of test and continuing thereafter. Medical staff said swallow was "perfect." Says lump in throat and at rib cage continues. Has been trying to sleep sitting up. Approximately 6 months ago completed yearlong course of antibiotics to deal with atypical micro bacterium avium intracellulare following imunosuppressant therapy to deal with Behcet's. She says it feels how she felt when she got pneumonia at the onset of the MAC. She is allergic to penicillin. There's the whole kitchen sink. Question is what to do and how urgent.

Answered by Dr. Dr. Naveen Kumar Nanjasetty (2 hours later)

Brief Answer:
Reaction to barium...

Detailed Answer:
Hi

Thanks for posting the query and elaborate history. I will try my best to help you with this problem.

After going through the history, I am of the opinion that she may be having lower cranial palsy, which is the main cause of her aspiration in the past.

Pain in the throat could be secondary to the reaction caused because of the barium. And, the pain in the ribs may be either due to lower respiratory tract infection or aspiration.

She may require mild antibiotics and analgesics. Please consult your doctor for a complete examination of the larynx and the lower cranial nerves.

Hope I have answered the query; I'll be available for the follow up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Dr. Naveen Kumar Nanjasetty (2 hours later)

This is very interesting. However, I should clarify that she has not been aspirating in the past or, to our knowledge, during the procedure.

She does have a mild Chiari malformation and I am wondering if that plays any role?

Answered by Dr. Dr. Naveen Kumar Nanjasetty (7 hours later)

Brief Answer:
Chiari formation can cause cranial nerve palsy...

Detailed Answer:
Hi

Thanks for writing back. I sincerely apologise for the delay in answering the query.

The reason behind me presuming that she could be having aspiration is the history, it has been mentioned that she sleeps in the propped up position. This type of difficulty in sleep while lying down is noticed when there is aspiration or respiratory failure. As there is no mention of the latter, I presumed she could be having aspiration of the secretions.

Chiari formation can cause lower cranial nerve palsy, which can lead to various swallowing related issues.

The barium swallow can have minimal side effects such as constipation, swallowing problem, reaction to the medicine, aspiration, tearing of the esophagus, etc.

I would suggest you to use paracetamol for the fever, instead of aspirin (unless used for other cardiac or vascular related problems).

Hope this clarifies your doubts.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj