Detection of pharyngeal perforation: Comparison of aqueous and barium-containing contrast agents

OBJECTIVE. We sought to assess the value of aqueous and barium-containing c ontrast agents in the detection of pharyngeal perforation. SUEJECTS AND METHODS, Visual and objective in vitro comparisons of an iodin ated aqueous contrast agent, a 50% weight/volume barium suspension, and a 1 00% weight/volume barium suspension were performed. Moreover to exclude pha ryngeal perforation after surgery, we prospectively examined 109 patients b y pharyngography, using the aqueous contrast agent and the 100% weight/volu me barium suspension. All patients with a pharyngeal perforation were follo wed up clinically to exclude complications due to barium application. RESULTS. As opposed to the 100% weight/volume barium suspension, in vitro c omparison between the aqueous contrast agent and the 50% weight/volume bari um suspension yielded no substantial differences. Seventeen perforations co uld be detected with the aqueous contrast agent. Although 10 of 17 perforat ions could be slightly better visualized with the 100% weight/volume barium suspension, two perforations were missed with this agent. Five perforation s were equally well detected with both. CONCLUSION. Because of a higher radiopacity, 100% weight/volume barium susp ensions may more sharply delineate perforations. However, in contrast to aq ueous contrast media, narrow pharyngeal perforations can be missed. Thus, t he use of a 100% weight/volume barium suspension does not improve the detec tion of pharyngeal perforation.