Fatal iatrogenic BaSO4 embolism: Morphological and ultrastructural findings confirmed by X-ray microanalysis and ICP-AES

A 42-year-old woman died from massive barium sulfate (BaSO4) lung embolism after a balloon catheter intended for elective colonography was inserted into her vagina. The vaginal insertion of the balloon catheter caused a bilateral laceration of the vaginal wall which was followed by penetration of BaSO4 into the afferent veins and massive pulmonary embolism. Fluoroscopy performed during the fatal events and post-mortem X-rays revealed a radio-opaque substance in the vagina and uterus, the pelvic vessels and the vena cava, the right heart chambers, the lungs, and the kidneys. In addition to lungs, finely granular intravascular particles were demonstrated histologically in several organs including the brain and the glomerular capillaries. Scanning (SEM) and transmission (TEM) electron microscopy together with X-ray microanalysis, and inductively coupled plasma atomic emission spectrometry (ICP-AES) allowed the definite identification of BaSO4 in lungs and confirmed its capacity to penetrate the pulmonary filter and to embolise via the systemic circulation in various organs.