Beware the wrong way! A report on gastrografin inhalation

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 B), with the right part being more involved because of the straight orientation of the right bronchus.