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An 84-year-old man with coronary artery disease, atrial fibrillation, chronic obstructive pulmonary disease, and congestive heart failure was admitted to the hospital because of a decrease in mental status. He was found to have profound hyponatremia and questionable lung infiltrates. The patient reported that he had choked on his food and had difficulty in swallowing. He had a history of recurrent pneumonia. A barium-swallow examination was performed. The ingestion of barium contrast material under fluoroscopic observation showed aspiration into the tracheobronchial tree. The patient had mild dyspnea during the procedure. Chest radiography showed clear lung parenchyma with barium seen in the lower lobes bilaterally. No specific cause for the aspiration was found. The patient was referred for placement of a percutaneous endoscopic gastrotomy tube. His respiratory symptoms were managed conservatively, and he was discharged to a nursing home.
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