| ## Page 1 |
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| BARIUM SWALLOW |
|
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| DR.SHAIK FARID |
| RMMCH |
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| --- |
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| ## Page 2 |
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| INTRODUCTION |
|
|
| ¢ Barium swallow is |
| a radiological |
| study of pharynx |
| and esophagus |
| upto the level of |
| stomach with the |
| help of contrast. |
|
|
| --- |
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| ## Page 3 |
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| EMBRYOLOGY OF PHARYNX |
|
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| ¢ Head & neck structures |
| are derived from |
| pharyngeal arches 1 & 2. |
|
|
| ¢ Each arch contain similar |
| component derived from |
| endoderm,ectoderm & |
| mesoderm. |
|
|
| ¢ The cavity within the |
| pharyngeal arches forms |
| the pharynx. |
|
|
| --- |
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| ## Page 4 |
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| BOUNDRIES OF PHARYNX |
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| Anteriorly-mouth & nasal choanae |
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| Superiorly-soft palate &portion of skull |
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| Inferiorly- postr of tongue |
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| Posteriorly- pharnygeal constrictors |
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| --- |
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| ## Page 5 |
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| PARTS |
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| ¢ Naso - ant.pharynx joins nasal cavity |
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| ¢ Oro- midportion of pharynx joins oral cavity |
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| ¢ Hypo-inferior pharynx joins larynx. |
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| --- |
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| ## Page 6 |
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| NASOPHARYNX |
|
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| get ph tympanic |
|
|
| ¢ Lies behind the nasal |
| cavity. |
|
|
| ¢ Postero-superiorly this |
| extends from the level |
| of the junction of the |
| hard and soft palates to |
| the base of |
| skull, laterally to include |
| the fossa of |
| Rosenmuller. |
|
|
| ¢ The inferior wall |
| consists of the superior |
| surface of the soft |
| palate. |
|
|
| --- |
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| ## Page 7 |
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| OROPHARYNX |
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| Nasopnaryny |
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| Orophar nx |
|
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| Larwngopharyns |
|
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| Lies behind the oral |
| Cavity. |
|
|
| The anterior wall - the |
| base of the tongue and |
| the epiglottic valleculae. |
|
|
| the lateral wall — |
| tonsil, tonsillar |
| fossa, and tonsillar |
| (faucial) pillars; |
|
|
| the superior wall - |
| inferior surface of the |
| soft palate and the |
|
|
| --- |
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| ## Page 8 |
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| Figure 1—8wallowing Anatomy |
|
|
| Levels between C4 to C6, it |
| includes the pharyngo- |
| esophageal junction (postcricoid |
| area), the piriform sinus and the |
| posterior pharyngeal wall. |
|
|
| Lined with a stratified |
| squamous epithelium. |
|
|
| It lies inferior to the upright |
| epiglottis and extends to the |
| larynx, where the respiratory |
| and digestive pathways diverge. |
|
|
| At that point, the |
| laryngopharynx is contunious |
| with esophagus posteriorly. |
|
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| --- |
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| ## Page 9 |
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| EMBRYOLOGY OF ESOPHAGUS |
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|
| ¢ Primitive gut tube forms during 4" week of |
| gestation. |
|
|
| ¢ It is derived from incorporation of the dorsal |
| part of the definitive yolk sac into embryo due |
| to embryonic folding. |
|
|
| --- |
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| ## Page 10 |
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| ¢ Primitive gut is divided into foregut,midgut and |
| hindgut. |
|
|
| ¢ Laryngotracheal diverticulum develop in the |
| midline of the ventral wall of the foregut. |
|
|
| ¢ The distal end enlarges to form lung buds,which |
| is separated from the foregut by tracheo- |
| esophageal folds. |
|
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| --- |
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| ## Page 11 |
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| Stomodeum Pharynx |
| Septum |
| transversum |
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| Esophageal |
| region |
|
|
| Gastric and |
|
|
| duodenal region |
| Yolk stalk |
| and |
| Vitelline artery |
|
|
| Celiac artery |
|
|
| Liver |
|
|
| Superior |
| mesenteric artery |
|
|
| Allantoais |
| Midgut |
| Proctodeum |
|
|
| Inferior |
| mesenteric artery |
|
|
| Cloacal membrane Cloaca Hindgut |
|
|
| — — rc (kt it ~ |
|
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| --- |
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| ## Page 12 |
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| ¢ Tracheo-esophageal fold fuse in midline to form |
| tracheo-esophageal septum. |
|
|
| ¢ The foregut divide into laryngotracheal |
| tube(larynx,trachea,bronchi &lungs) ventrally and |
| esophagus dorsally. |
|
|
| ¢ Esophagus is initially short ,out lengthens with |
| descent of heart and lungs. |
|
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| --- |
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| ## Page 13 |
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| respiratory |
| diverticulum / |
|
|
| week : week 4 |
| lateral view front view |
|
|
| end of week 4 |
| front vwrewy |
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|
| C—( TT —E—_ lO |
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| --- |
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| ## Page 14 |
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| CONGENITAL ANOMALIES |
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| esophageal atresia, EA, |
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| tracheoesophageal |
| fistula, TEF, |
|
|
| esophageal stenosis, |
| esophageal cyst, |
| tracheobronchial remnant, |
|
|
| esophageal atresia and |
| tracheoesophageal |
| fistula, EA-TEF, |
|
|
| esophageal web, |
| esophageal muscular |
| hypertrophy, |
|
|
| esophageal duplications, |
| columnar epithelium— |
| lined lower esophagus, |
| Barrett's |
|
|
| esophagus, laryngotrache |
| oesophageal cleft, LTEC |
|
|
| --- |
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| ## Page 15 |
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| ANATOMY OF ESOPHAGUS |
|
|
| ¢ Flattened muscular |
| tube,size 18 to 26cm |
| beginning at lower border |
| of cricoid cartilage(opp 6* |
| cervical vertebra) and |
| ending at cardiac orifice of |
| stomach(opp 11" cervical |
| vertebra) |
|
|
| ¢ Divided into 3 anatomical |
| segments |
| i.e.,cervical,thoracic & |
| abdominal |
|
|
| --- |
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| ## Page 16 |
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| ¢ Cervical esophagus extend from pharyngeal |
| junction to suprasternal notch and is abt 4- |
| 5cm. |
|
|
| ¢ At this level,eosophagus bordered anteriorly |
| by trachea,post by vetebral column and lat by |
| carotid sheath and thyroid gland. |
|
|
| --- |
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| ## Page 17 |
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| ¢ Thoracic esophagus extend from suprasternal |
| notch(opp 11) to diaphragmatic hiatus(opp |
| T10).18cm in length. |
|
|
| ¢ Anteriorly lies the trachea, rt pulmonary |
| artery, left main bronchus & diaphragm.post it |
| rest on vertebral column and closely related to |
| thoracic duct, azygous & hemiazygous vein. |
|
|
| --- |
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| ## Page 18 |
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| ¢ Abdominal esophagus extend from |
| diaphragmatic hiatus to orifice of cardia of |
|
|
| stomach.size abt 1 cm. |
|
|
| ¢ Its right border is continuous with lesser |
| curvature & left border is demarcated from |
| fundus by esophagogastric angle of |
| implantation(angle of His) |
|
|
| --- |
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| ## Page 19 |
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| Incisors |
| 0 |
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| Subsite Description 4 |
|
|
| Cermical esophagus |
|
|
| Upper 13 18 |
| (Froximaly L |
| Upper thoracic esophagus |
| 24 |
| Middle 443 Mid thoracic esophagus |
|
|
| 32 |
|
|
| (Distal) Lower thoracic esophagus |
|
|
| 40 |
|
|
| Cardioesophageal |
| Junction |
|
|
| --- |
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| ## Page 20 |
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| ESOPHAGEAL CONSTRICTION |
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|
| oe |
|
|
| ¢ Superiorly: level of |
| Cricoid |
| cartilage, juncture with |
| pharynx |
|
|
| e Middle: crossed by aorta |
| and left main bronchi |
|
|
| e Inferiorly: |
| diaphragmatic sphincter |
|
|
| --- |
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| ## Page 21 |
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| SPHINCTERS |
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| Two high pressure zones prevent the backflow |
| of food: |
|
|
| ¢ Upper Esophageal sphincter. |
| ¢ Lower Esophageal sphincter. |
|
|
| ¢ It is located at upper and lower end of |
| esophagus. |
|
|
| --- |
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| ## Page 22 |
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| LAYERS OF ESOPHAGUS |
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| Structurally, esophagus wall composed of 4 |
| layers: |
|
|
| ¢ Innermost mucosa, |
|
|
| e Submucosa, |
|
|
| ¢ Muscularis propria |
|
|
| ¢ Adventitia. |
|
|
| ° No serosa. |
|
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| --- |
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| ## Page 23 |
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| BLOOD SUPPLY |
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| Arterial supply |
|
|
| Branches of inf thyroid artery - UES & cervical |
| esophagus. |
|
|
| Paired aortic esophageal arteries or terminal |
| br.of bronchial artery — thoracic esophagus |
| Left gastric & br.of left phrenic art- LES & |
| distal esophagus |
|
|
| --- |
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| ## Page 24 |
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| Arteries of Esophagus |
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|
| , Theracic part |
|
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| --- |
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| ## Page 25 |
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| VENOUS DRAINAGE |
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| ¢ Proximal & distal esophagus drains into azygous |
| veins. |
|
|
| ¢ Mid-esophagus drains into collaterals of left |
| gastric vein,br. of portal vein. |
|
|
| ¢ Submucosal connection between portal and |
| systemic venous system in distal esophagus form |
| esophageal varices in portal hypertension. |
|
|
| --- |
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| ## Page 26 |
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| Weins of Esophagu |
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| Inferior thyroicl weim—_ a Iinkerior thyroid weir |
|
|
| —Internmal puget |
| Internal jugular vein aNtOTTWAs BUA |
|
|
| ween |
| External jugular wein |
|
|
| Subclay |
|
|
| mn Subclavian |
| Vertebral vein— ¢ vein |
|
|
| “Thoracic |
| duct |
| Right |
| brachiocephalic vein “Left brach |
|
|
| cephalic vein |
|
|
| Superior wena cava- - ~Left superior |
|
|
| intercostal vein |
|
|
| Esophageal veins |
| plexerst |
|
|
| Esophagus \CCessOry |
| — hemiazygos vein |
|
|
| Goth cigght jecsteriors |
|
|
| —Wenac comitantes |
|
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| Ivein— |
| aires of vagus nervy |
|
|
| Se Heres 2yygeos |
| weir ucous venous plexus |
|
|
| Inferior vena cava (cut) |
| if eft interior phrenic |
|
|
| Shert gastric veins |
|
|
| Hepatic |
| Wires — |
|
|
| Interior |
| wen |
| cavan- |
|
|
| bteegosatic |
|
|
| ~Splen |
| or plonix |
|
|
| “Let |
|
|
| suprarennal > Omenta |
|
|
| ve (epiploic |
|
|
| Righs renal vein ; ; “Lett ene |
| o-ome |
|
|
| a |
| Lett gastric vein~ |
| mp rig vlcric |
|
|
| Right gastric vein |
|
|
| ~ |
| Superior mesenteric vein Inferior mesentert |
|
|
| Esophageal branches of left gastric wei ht g4stro-omental (gastroepiploic) wein |
|
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| --- |
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| ## Page 27 |
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| NERVE SUPPLY |
|
|
| Extrinsic network |
| —sympathetic & parasympathetic. |
| SYMPATHETIC: |
| -Neck - sup & inf cervical ganglion , |
| -Thorax - upper thoracic and splanchnic nerve . |
| PARASYMPATHETIC : |
|
|
| - from recurrent laryngeal nerve & br of vagus |
| in thorax & abdomen. |
|
|
| Intrinsic |
| -from 2 intramural plexuses |
| - 1 in submucous layer. |
|
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| --- |
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| ## Page 28 |
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| upenorganghon of vagus nemwe |
| Superior cervical sympathetic ganglion |
| Interior ganglion of wagus nerve |
| Esophagus t J Fharmyngeal branch of yagus nerve |
| Wagus nenre (*) |
| Supernorlanngeal nenre |
| Cervical sympathetic trunk |
| en hiliddle cervical sympathetic ganglion |
| alne aT ati ; - Cemical (sympathetic and vagal) cardiac nemes |
| } Wertebral ganglion of cemical sympathetic trunk |
| subclavia i ;| - Ansa subslawia |
| |
| Se — Branch te esophagus and recument |
| heme from stellate ganglion |
| |
| Cemicothoracic (stellate) ganglion |
| Srd intercostal |
| |
| : ‘ , |
| neve : mh Y , | Lett recunent lanngeal neme |
| —aa q P Thoracic twagal and sympathetic) |
| Cae Z a YG = cardiac branches |
| Gray and white rami |
| communicantes — |
| |
| Ord thoraci« |
| sympathetic |
| ganglion |
| |
| = i) il , Esophageal plexus |
| |
| Th ; + ae ' ; t = Canterior portion) |
| |
| oracia =~ | : ; |
| |
| sympathetic i - |
| |
| trunk — ; i Branches to esophageal |
| |
| << —_— |
| |
| ‘ t Plexus from sympathetic |
| Right greater j trunk, greater splanchnic |
| splanchnic neve { nene and thoracic aortic |
| . ove plexus |
| Sympathetic { : |
| tibers along i ; Left greater splanchnic nemne |
| lett inferior ! \ J |
| PACS a ery 4 Anterior vagal trunk |
| |
| Branch of |
| |
| posterior vagal , F : Vagal branch to hepatic plexus |
| trunk to seas ent 5 fe ? wia lesser omentum |
| plexus ‘ ; , |
| |
| Greater |
| splanchnic |
| |
| Wagal branch te fundus |
| newes |
| |
| and body of stomach |
| |
| Sympathetic fibers |
| along esophageal |
| |
| --- |
| |
| ## Page 29 |
| |
| LYMPHATIC DRAINAGE |
| |
| ¢ Originate from 2 plexus-submucosal layer & |
| other within the muscle layer. |
| |
| ¢ Upper 2/3 flow in cranial direction. |
| |
| ¢ Lower 1/3 flow in caudal direction. |
| |
| --- |
| |
| ## Page 30 |
| |
| Lymph Vessels and Nodes of Esophagus |
| |
| Inferior deep cer |
| (intermal jugulart |
| |
| Postenor |
| |
| i parietal nodes |
| ar and inheric |
| |
| obronchial |
| |
| Juxtacsophagee |
| and superia |
| |
| phrenic nodes |
| |
| --- |
| |
| ## Page 31 |
| |
| BARIUM SWALLOW |
| |
| ¢ It is a medical imaging procedure used to |
| examine upper gastrointestinal tract,which |
| include the esophagus and to a lessr extent |
| the stomach. |
| |
| ¢ The contrast used is barium sulfate. |
| |
| --- |
| |
| ## Page 32 |
| |
| CONTRAST |
| |
| ¢ TYPES Glan TRAST STUDY |
| |
| (i) SINGLE CONTRAST STUDY |
| |
| (ii) DOUBLE CONTRAST STUDY |
| |
| --- |
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| ## Page 33 |
| |
| CONTRAST USED |
| |
| 100% BARIUM SULPHATE PASTE |
| 80% BARIUM SULPHATE SUSPENSION |
| |
| 30% BARIUM SULPHATE SUSPENSION FOR HIGH |
| KV TECHNIQUE |
| |
| 200-250% HIGH DENSITY,LOW VISCOSITY FOR |
| DOUBLE CONTRAST STUDY |
| |
| --- |
| |
| ## Page 34 |
| |
| INDICATION |
| |
| Dysphagia |
| |
| Heart burn, retrosternal pain, regurgitation & odynophagia. |
| Hiatus hernia |
| |
| Reflux oesophagitis |
| |
| Stricture formation. |
| |
| Esophageal carcinoma. |
| |
| Motility disorder like |
| |
| i. Achalasia |
| ii. diffuse esophageal spasms. |
| Pressure or invasion from extrinsic lesions. |
| Assessment of abnormality of |
| i. pharyngo esophageal junction including zenkers diverticulum |
| ii. cricoid webs |
| iii. cricopharyngeal Achalasia. |
| |
| --- |
| |
| ## Page 35 |
| |
| CONTRAINDICATION |
| |
| ¢ Suspected leakage from esophagus into the |
| mediasternum or pleura and peritoneal |
| cavities. |
| |
| ¢ Tracheo-esophageal fistula |
| |
| --- |
| |
| ## Page 36 |
| |
| XRAY VIEW |
| |
| ¢ SOFT TISSUE NECK — AP & LAT — SCOUT |
| |
| ¢ NECK-AP & LATERAL |
| |
| ¢ THORAX-RAO VIEW |
| |
| --- |
| |
| ## Page 37 |
| |
| NORMAL-AP /LAT VIEW - SCOUT |
| |
| . Sia Rey |
| |
| --- |
| |
| ## Page 38 |
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| AP/LAT VIEW WITH BARIUM |
| |
| --- |
| |
| ## Page 39 |
| |
| RAO VIEW |
| |
| --- |
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| ## Page 40 |
| |
| PATIENT PREPARATION |
| |
| None in particular but advisable to be in NPO |
| prior to the procedure . |
| |
| Ensured that no contraindication to the |
| pharmacological agent used. |
| |
| Check pregnancy state. |
| |
| Procedure should be explained to patient before |
| undergoing the procedure. |
| |
| --- |
| |
| ## Page 41 |
| |
| TECHNIQUE |
| |
| ¢ PHARYNX |
| |
| ¢ -One mouthful contrast bolus with high |
| density(250% w/v). |
| |
| ¢ -Patient is asked to swallow once and stop |
| swallowing there after. |
| -This is to get optimum mucosal coating. |
| |
| -frontal and lateral view x-ray taken. |
| |
| --- |
| |
| ## Page 42 |
| |
| ESOPHAGUS |
| Single contrast |
| |
| -Multiple mouthful 80% w/v barium |
| suspension given. |
| -prone swallow to assess esophageal |
| contraction. |
| |
| -useful in esophageal |
| compression, displacement or disordered |
| motility. |
| |
| --- |
| |
| ## Page 43 |
| |
| Double contrast |
| -Contrast high density,low viscosity(200-250%). |
| -15-20 ml given & asked to swallow. |
| |
| -Then effervescent powder given with another |
| mouthful of barium. |
| |
| -In erect posture,gas tend to stay up so |
| adequate distention stays longer time. |
| Inj.buscopan I.V given before the procedure to |
| keep esophagus distended for longer time. |
| |
| --- |
| |
| ## Page 44 |
| |
| SPECIFIC CONDITION |
| |
| --- |
| |
| ## Page 45 |
| |
| ¢ PHARYNGEAL WEB |
| |
| ¢ 50/50 dilution of standard |
| high density barium. |
| |
| © Film in supine for frontal |
| and erect for lateral view |
| |
| --- |
| |
| ## Page 46 |
| |
| ¢ Partially obstructing cervical |
| esophageal web. Frontal view |
| shows a |
| circumferential, radiolucent |
| ring (straight white arrows) in |
| the proximal cervical |
| esophagus. Partial |
| obstruction is suggested by a |
| jet phenomenon (black |
| arrows), with barium |
| spurting through the |
| ring, and by mild dilatation of |
| the proximal cervical |
| esophagus. |
| |
| --- |
| |
| ## Page 47 |
| |
| FOREIGN BODY IMPACTION |
| |
| * To detect the level of |
| obstruction in case of |
| radiolucent foreign |
| body in |
| esophagus,marsh |
| mellow coated with |
| barium is swallowed. |
|
|
| ¢ Passage of marsh |
| mellow will be hindered |
| at the level of |
| obstruction |
|
|
| --- |
|
|
| ## Page 48 |
|
|
| Xray showing foreign body |
|
|
| ¢ AP and lateral plain films |
| showing a metallic foreign |
| body in the upper |
| esophagus. Most foreign |
| bodies are found at the |
| level of the |
| cricopharyngeus muscle. |
|
|
| --- |
|
|
| ## Page 49 |
|
|
| Sceleroderma esophagus |
|
|
| ¢ Upright left posterior |
| oblique spot image from |
| double-contrast |
| esophagography shows |
| two wide-mouthed |
| sacculations en face |
| (black arrows) in upper |
| and mid thoracic |
| esophagus. Note how |
| upper sacculation extends |
| superiorly just above level |
| of aortic arch (white |
| arrow). |
|
|
| --- |
|
|
| ## Page 50 |
|
|
| DYSPHAGIA |
|
|
| ¢ Post swallow oral (thick |
| arrow) and pharyngeal |
| (thin arrow) stasis in a |
| patient with base of |
| tongue cancer. |
|
|
| Source: Cancer Conirel © 2002 H. Lee Mofil! Cancer Center and Ragearch Inetitute, Inc. |
|
|
| --- |
|
|
| ## Page 51 |
|
|
| MEDIASTINAL MASS |
|
|
| ¢ Image showing anterior |
| mediastinal mass in |
| lateral view. |
|
|
| --- |
|
|
| ## Page 52 |
|
|
| CARCINOMA |
|
|
| ¢ Preferably high viscosity |
| with normal density |
| barium is used. |
|
|
| ¢ Classical finding in |
| carcinoma -rat tail |
| appearance. |
|
|
| --- |
|
|
| ## Page 53 |
|
|
| CA ESOPHAGUS |
|
|
| With shouldering |
|
|
| The stenotic segment is long giving a “" *rat-tail” appearance |
| |
| Barium swallow shows mild dilatation of the esophagus with irregular |
| stenotic lesion in the lower end of the esophagus “moth eaten |
| appearance |
| |
| --- |
| |
| ## Page 54 |
| |
| HIATUS HERNIA |
| |
| * High abdominal pressure is |
| required to demonstrate. |
|
|
| ¢ Pt has to strain. |
|
|
| * Lie down,straighten legs & |
| then raise them up. |
|
|
| ¢* Manual compression of |
| abdomen. |
|
|
| ¢ Pt stands upright,ask him to |
| bend downward with leg |
| straight. |
|
|
| * Stomach should be |
| distended to demonstrate |
| HH. |
|
|
| --- |
|
|
| ## Page 55 |
|
|
| HIATUSIMERNIA |
|
|
| Barium meal in Trendlenberg position |
| Displacement of the cardio-esophageal junction |
| above the esophageal hiatus |
|
|
| Part of the stomach is present in the chest |
| Reflux of barium into the esophagus |
|
|
| --- |
|
|
| ## Page 56 |
|
|
| ACHALASIA CARDIA |
|
|
| ¢ Eosophagus should be |
| cleaned thoroughly |
| (aspirate &wash) — |
| secondary achalasia d/t |
| Ca esophagus not missed. |
|
|
| ¢ Barium 80% w/v used,pt |
| erect position. |
|
|
| ¢ Mecholyl test- |
| hyperperistalsis,pain&stre |
| ak of contrast entering |
| stomach. |
|
|
| --- |
|
|
| ## Page 57 |
|
|
| ACHALSIA CARDIA |
|
|
| ¢ Barium swallow |
| showing dilatation of |
| the esophageal body |
|
|
| *With short segment |
| stricture. |
| |
| * A “bird-peak " like |
| tapering of the |
| esophagus at the GE |
| junction. OR |
|
|
| *A Sigmoid “ Mega |
| esophagus |
| |
| --- |
| |
| ## Page 58 |
| |
| DIFFUSE ESOPHAGEAL SPASM |
| |
| Barium swallow shows |
| irregular areas of |
| narrowing and |
| dilatation ----- “Shish |
| kebab” “corkscrew” |
| “rosary bead" |
| esophagus |
| |
| The esophageal muscle |
| is hypertrophied, but |
| histologically normal |
| |
| --- |
| |
| ## Page 59 |
| |
| ESOPHAGEAL VARICES |
| |
| ¢ Supine right side up |
| position, high |
| density thin barium |
| should be used. |
| |
| e Varices are best |
| demonstrated in |
| mucosal relief study |
| after using |
| Buscopan/ valsalva |
| maneuver. |
| |
| --- |
| |
| ## Page 60 |
| |
| ESOPHAGEAL VARICES |
| |
| ¢ Mild dilatation of the |
| esophagus |
| |
| with multiple |
| persistent filling |
| defects in the lower |
| third of the |
| esophagus and/or |
| longitudinal furrows. |
| |
| A |
| |
| --- |
| |
| ## Page 61 |
| |
| TRACHEOESOPHAGEAL FISTULA |
| |
| ¢ Congenital/Acquired |
| ¢ Ideal contrast non ionic |
| water soluble media |
| |
| ¢ Barium fluid like & pt |
| lying laterally. |
| |
| ¢ Incase fistula not |
| identify laterally, put in |
| prone. |
| |
| ¢ If fistula seen, stop |
| procedure as barium |
| aspiration result in |
| inflammation and |
| granuloma. |
| |
| --- |
| |
| ## Page 62 |
| |
| TRACHEOESOPHAGEAL FIST(INFANT) |
| |
| A Ryle’s tube is introduced to the level of mid |
| esophagus & contrast is injected. |
| |
| The tube is withdrawn slowly. |
| This will force the contrast thro’ any small fistula. |
| |
| Both lat & prone views to be assessed. |
| |
| --- |
| |
| ## Page 63 |
| |
| Oblique barium |
| esophagogram |
| demonstrates a fistula |
| (arrow) arising from the |
| anterior esophagus and |
| _ extending |
| anterosuperiorly to the |
| trachea. |
| |
| --- |
| |
| ## Page 64 |
| |
| ESOPHAGEAL A-RING |
| |
| ¢ Esophageal A-ring |
| due to muscular |
| contraction at |
| junction of tubular |
| and vestibular |
| esophagus. It varies |
| during examination |
| and may not persist. |
| |
| --- |
| |
| ## Page 65 |
| |
| ESOPHAGEAL B-RING |
| |
| * The esophageal B-ring is |
| located at the |
| squamocolumnar |
| junction, also termed the 'Z' |
| line. |
|
|
| * On the left a patient witha |
| 'B' ring (arrows) several cm |
| above diaphragm at the |
| apex of sliding hiatus |
| hernia. |
|
|
| Note unchanged |
| appearance on these two |
| images. |
|
|
| --- |
|
|
| ## Page 66 |
|
|
| GASTRO ESOPHAGEAL REFLUX |
|
|
| SIPHON TEST |
| Fill the stomach with 50% barium(150-200ml) |
|
|
| Follow this 1-2 mouthful of water to remove traces of |
| barium in esophagus |
|
|
| Pt in supine with left side raised 15% up |
| Keep one mouthful of water in pt mouth |
|
|
| Ask pt to swallow water-a jet of barium will shoot into |
| water column as it enter GO junction |
|
|
| Alternatively with full stomach,ask pt to roll side to |
| side |
| Reflux will be seen |
|
|
| --- |
|
|
| ## Page 67 |
|
|
| ESOPHAGEAL REFLUX |
|
|
| ¢ Reflux oesophagitis |
| with a deep ulcer |
| (straight arrow). There |
| is also asymmetric |
| narrowing of the distal |
| esophagus with a |
| relatively abrupt cutoff |
| (curved arrow) at the |
| proximal border of the |
| narrowed segment. |
|
|
| --- |
|
|
| ## Page 68 |
|
|
| Barrett's Esophagus |
|
|
| ¢ The reticular |
| mucosa Is |
| characteristic of |
| Barrett's columnar |
| metaplasia, especi |
| ally with the |
| associated web- |
| like (arrow) |
| stricture. |
|
|
| --- |
|
|
| ## Page 69 |
|
|
| Candida Oesophagitis |
|
|
| ¢ The barium study |
| shows numerous fine |
| erosions and small |
| plaques due to |
| Candida albicans in |
| immunocompromised |
| patient. |
|
|
| --- |
|
|
| ## Page 70 |
|
|
| LEFT ATRIAL ENLARGEMENT |
|
|
| ¢ Right anterior |
| oblique film and |
| barium swallow |
| demonstrates left |
| atrial compression |
| of the esophagus |
| confirming left |
| atrial dilation. |
|
|
| --- |
|
|
| ## Page 71 |
|
|
| COARCTATION OF AORTA |
|
|
| ¢ Barium in the |
| esophagus |
| exhibits the |
| ‘reverse 3 sign’ |
| outlining the |
| medial site of the |
| aortic indentation |
| in the descending |
| aorta |
|
|
| --- |
|
|
| ## Page 72 |
|
|
| ZENKERS DIVERTICULUM |
|
|
| --- |
|
|
| ## Page 73 |
|
|
| KILLIAN JAMIESON DIVERTICULUM |
|
|
| * Killian-Jamieson |
| diverticulum is a pulsion |
| diverticulum, that protrudes |
| through a lateral anatomic |
| weak site of the cervical |
| esophagus below the |
| cricopharyngeus muscle. |
|
|
| AP view shows diverticulum |
| (arrow) originating laterally. |
| Lateral view confirms |
| diverticulum does not |
| Originate posteriorly as a |
| Zenkers diverticulum would. |
|
|
| --- |
|
|
| ## Page 74 |
|
|
| ¢ An oblique view of the |
| pharynx shows Zenker's |
| diverticulum (Z) with its |
| opening (short arrow) |
| above the prominent |
| cricopharyngeus (C). The |
| Killian-Jamieson |
| diverticulum (K) has its |
| opening (long arrow) below |
| the prominent |
| cricopharyngeus. |
|
|
| --- |
|
|
| ## Page 75 |
|
|
| COMPLICATION |
|
|
| ¢ Leakage of |
| barium from |
| unsuspected |
| perforation. |
|
|
| --- |
|
|
| ## Page 76 |
|
|
| COMPLICATION |
|
|
| ¢ Aspiration |
|
|
| --- |
|
|
| ## Page 77 |
|
|
| ae Thank u velgiftich, ‘ot 4 |
