Pathology of the Gastrointestinal Tract

2017 Edition
| Editors: Fátima Carneiro, Paula Chaves, Arzu Ensari

Barium Sulfate, Esophageal Inclusions

  • Mário Ferraz de OliveiraEmail author
Reference work entry


Barium granuloma


Barium sulfate is an inorganic compound (BaSO4) used since the early 1900s in colloidal suspension as a contrast medium in the gastrointestinal tract. Extravasation of barium into the wall of the esophagus through an injury in the mucosa (whatever the cause) provokes a reaction against it, as a granulation tissue or more commonly as a granulomatous reaction.

Clinical Features

It is a very rare complication and usually an incidental finding in biopsies or resection specimens for other reasons, but can present as a polypoid or ulcerative lesion.


Barium granulomas, when large enough, produce brownish-green masses associated with fibrosis.


Barium sulfate can be seen in histological sections in two ways, depending on the method the commercial suspensions are prepared:
  • Fine gray/greenish non-refringent granules (PAS negative)

  • Larger birefringent rhomboid crystals

Barium is located in the cytoplasm of macrophages and extracellular...

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References and Further Reading

  1. Levison, D. A., Crocker, P. R., Smith, A., Blackshaw, A. J., & Bartram, C. I. (1984). Varied light and scanning electron microscopic appearances of barium sulphate in smears and histological sections. Journal of Clinical Pathology, 37(5), 481–487.CrossRefGoogle Scholar
  2. Morson, B. C., & Dawson, I. M. P. (2003). Gastrointestinal pathology (4th ed., p. 86). Malden: Blackwell.Google Scholar
  3. Womack, C. (1984). Unusual histological appearances of barium sulphate – A case report with scanning electron microscopy and energy dispersive X ray analysis. Journal of Clinical Pathology, 37(5), 488–493.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing 2017

Authors and Affiliations

  1. 1.Serviço Anatomia PatológicaCentro Hospitalar Lisboa Central EPELisbonPortugal