Second Doctor

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Hello,

I'm a third year med student new to sdn. I'm doing my surgery rotation right now. Long story short -> Knowing that I'd like to become a radiologist, one of my attendings asked me to find information and do a presentation on mediastinitis secondary to leakage of barium from the esophagus. He was unaware of this phenomenon, heard it from a radiology attending, and asked me to look into it so that he, the residents, and the students can learn from it. I want to do a good job on it but information on this topic has been hard to come by. I asked the radiology attending and he told me that this was a pretty fundamental concept. He showed me a passage in one of his books (this was before I was asked to do a presentation on it, back when I was just asked to verify the phenomenon existed). I went back to see him today and he's going to let me photocopy the book tomorrow. But other than that, I can't seem to find this phenomenon anywhere. The hospital library revealed zilch. I found one article on Medline and Ovid from 2000, which my school doesn't have access to, so I've ordered it but I have no idea if it's even going to be germane.

Does anyone have any ideas on where I can get some information on this? If it's in a textbook, there had to have been some treatise on it at some point. Any help on this would be greatly appreciated!

Thank you
 

f_w

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It is a very fundamental concept in radiology, kind of like 'don't transect the portal vein' is in surgery. Nobody has done a double-blind study to see whether esophageal perforation with water in the mediastinum kills you any less than esophageal perforation with barium in it, based on experience of the people who introduced barium many moons ago, it is just something we don't do.

You won't find any recent literature on it, probably because most people now avoid using barium if there is only the slightest chance of leakage.

Having lost a very dear relative to Boerhave syndrome with granulomatous barium related mediastinitis, I can tell you that it is a very real phenomenon.
 

hans19

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Agree with FW

Its a kind of a radiology dogma. Take it or leave it, but nobody is going to go out of their way to prove or disprove it.

There was an article written in
Gastroenterology back in 1975, but I couldn't retrieve it electronically. Also there is a an article from _Radiology_ in 1997 that states from a review of 12 cases, that barium is no more harmful than water soluble. But come on, only 12 cases?
 
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f_w

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Gastric acid and food-stuff in the mediastinum is probably as detrimental to your health as barium.

My n=1 experience is a barium swallow on top of an esophageal rent. It ended after 10wks on a ventilator with the death of the patient. At the autopsy, the barium was distributed widely throughout the mediastinum. It is close to impossible to clear an infection if you have this goo that the body can't absorb sitting around.
 

sgap

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there is an article about this in a 97 issue of radiographics.

its all retrospective...but suggests that there is no such thing.

radiologic dogma, yes. nevertheless, i'm still gonna use diluted isovue on my leak studies.
 

colbgw02

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there is an article about this in a 97 issue of radiographics.

its all retrospective...but suggests that there is no such thing.

radiologic dogma, yes. nevertheless, i'm still gonna use diluted isovue on my leak studies.

I'm guessing this post came a little too late to make it into the medical student's presentation.
 

whatabro

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From what I remember of looking this up a year or so ago...really the only studies are rodent studies with some old, retrospective human studies mixed in.
 
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