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DI Radiology of the GI tract Universit Ottawa

VIEWS: 19 PAGES: 49

									GI Imaging
                    Densities
   X-ray allows visualization of different densities
    -Air
    -Fat
    -Water
    -Metal
    Visualization of the Esophagus

   Different density required for visualization
    i.e.: contrast
            Contrast Agents
   Water Soluble
    – Gastrografin
    – Low-osmolality


   Inert
    – Barium sulfate
    Single vs. Double Contrast
   Improved mucosal visualization
             Fluoroscope
 Real-time
     x-ray video
 Multiple sequential
     images
 Spot films
          Barium Studies
 (Video) Esophogram
 Barium Swallow
 UGI series
 Modified Barium
     Swallow
Gastroesophageal
     Reflux
            GERD & Barium
 Visualization of
     refluxing barium
 Patient position
 Valsalva


   Usefulness is
       arguable
    GERD Secondary Signs
 Hiatal Hernia (HH)
 Cricopharyngeus muscle spasm
 Reflux esophagitis
 Benign stricture
 Barrett’s esophagus
 Aspiration pneumonia
                Hiatal Hernia
 Extension of stomach into chest through
  esophageal hiatus
 2 types:
    – Sliding 95%
    – Para-esophageal 5%
        Not associated with GERD


   May be more prominent when supine
    Cricopharyngeous Muscle
 Posterior wall of pharyngoesophageal
  junction
 Normally relaxes with swallowing to allow
  passage of food
 Incomplete relaxation can be seen as
  protective mechanism in GER patients
 Smooth impression at C5-6 level
Cricopharyngeous Muscle
         Spasm
        Reflux Esophagitis
 Begins distally
 Thickened folds
 May have associated
     linear ulcers
 Benign Stricture
 Distal or mid-esophagus
 Smooth walls
 May be partially distensible
       Barrett’s Esophagus
 In approx. 10% of untreated reflux patients
 Metaplasia of normal squamous epithelium
  to a gastric columnar epithelium
 Nodular or granular mucosa
 Look for focal ulceration, stricture, and
  cancer (15% or 30x increase)
Barrett’s Esophagus
      Aspiration Pneumonia
 Appearance will vary with amount of
  aspirate, patient position, reaction to
  aspiration
 Often bilateral, associated atalectasis
 Posterior and basal areas more common
Aspiration Pneumonia
Aspiration
Esophageal Cancer
               Detection
 Barium studies are not as sensitive as
  endoscopy, but more readily available
 Suspect cases referred on to endoscopy
 CT, MRI not suitable for screening
      Barium Swallow Patterns
1.   Annular constricting
      Most common
      Many variations
2.   Polypoid mass
3.   Infiltrative
      In submucosa, may simulate benign stricture
4.   Ulcerated mass
Esophageal
  Cancer
Esophago-
 bronchial
  fistula
           Tumor Staging
 CT most commonly used
 Endoscopic ultrasound in some centers
Computed Axial Tomography
Computed Axial Tomography
               CT Staging
 Wall thickness
 Infiltration of paraesophageal fat planes
 Regional invasion (trachea, pleura,
      pericardium, vertebrae etc…)
 Lymphadenopathy
 Distant Metastases
Normal CT
Invasive Cancer
     Endoscopic Ultrasound
 Smaller lesions
 Assess wall involvement
Esophageal Motility
              Normal Motility
 Best seen prone
 3 phases:
    – Oral, pharyngeal, esophageal
          Esophageal Phase
   Primary wave:
    – Initiated by swallowing reflex
   Secondary Wave:
    – As response to esophageal distension
Normal Swallow
          Abnormal Motility
 Non-specific finding
 Seen in reflux esophagitis, radiation injury,
  caustic ingestion, myxedema, diabetes
  mellitus…
       Corkscrew esophagus
   Tertiary esophageal waves
    – Non-propulsive
    – Corkscrew or beaded
       appearance
             Scleroderma
 Fibrosis of smooth muscle
 Dilated esophagus with widely patent GEJ
 Resultant reflux
 Reflux esophagitis => ulceration =>
  stricture (mild) => Barrett’s => neoplasm
Scleroderma
               Achalasia
 Diffusely decreased or absent peristalsis
 Lower esophageal sphincter fails to relax
 Smooth, tapered distal esophageal
  narrowing
 Some passage of food in upright position
Achalasia
    Neuromuscular Disorders
 Most common => stroke
 Parkinsonism, Alzheimer’s, multiple
  sclerosis, CNS neoplasms, traumatic injury
 Modified barium swallow
Zenker’s Diverticulum
                Zenker’s
 Herniation at posterior midline above UES
 Horizontal & oblique fibers of inferior
  constrictor muscles => Killian’s dehiscence
 Associated incomplete cricopharyngeus
  muscle relaxation
 Neck at superior aspect of sac
 Midline, but lateral extension with growth
Zenker’s Diverticulum
Zenker’s Diverticulum

								
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