Contrast Studies

Yeast Infection No More

Curing Candida Albicans Naturally

Get Instant Access

With the increasing availability and popularity of upper endoscopy, the number of upper gastrointestinal contrast studies that are performed annually continues to decline. However, contrast studies play a vital role in the diagnosis of many esophageal diseases and in the follow-up after surgery or other interventions. The contrast esophagogram is the main contrast study performed for imaging of the esophagus. TECHNIQUE

Contrast esophagography can be performed with a variety of contrast agents and techniques, depending on the clinical indication.

The most sensitive method for examination of the esophageal mucosa is the double-contrast esophagogram. The technique allows visualization of processes that affect the esophageal mucosa, such as esophageal ulcers, early carcinomas, Barrett's esophagus, esophagitis, and others. During this examination, the patient is standing and at a slightly oblique angle. He or she swallows 4 to 6 g of effervescent granules with 10 ml of water and then immediately gulps approximately 50 to 75 ml of high-density (thick) barium (250% wt/vol). The effervescent granules will release carbon dioxide in the esophagus and stomach; the esophagus will therefore be distended and coated with the thick barium ( Fig. 4-1 ). The distention is only transient, so the radiologist must quickly obtain the necessary spot films of the esophagus while it is maximally distended.

In patients who are unable to stand or who are unable to tolerate the effervescent granules, a single-contrast examination of the esophagus can be performed with a dilute (thin) barium suspension. To obtain single-contrast views of the esophagus, the patient is typically in the prone, right oblique position and drinks contrast medium Figure 4-1 Normal double-contrast esophagogram demonstrates good esophageal distention and coating. The extrinsic impressions from the aortic knob (AK) and left main stem bronchus (LB) are normal.

Figure 4-2 Normal single-contrast esophagogram. The esophagus appears as a continuous column filled with thin barium.

Figure 4-3 Esophagogram with barium paste according to the mucosal relief technique demonstrates multiple serpiginous filling defects (arrows) in the mid and distal esophagus, compatible with esophageal varices. With this technique, the esophagus is collapsed and coated with barium paste.

Figure 4-4 Single-contrast esophagogram demonstrates a hiatal hernia (HH). A nonstenotic Schatzki ring (curved arrows) with a diameter of 2.5 cm is also present. The patient was asymptomatic. There is a moderate hiatal hernia. Spasm is present in the lower esophagus (straight arrows).

Figure 4-5 Double-contrast esophagogram demonstrates a large ulcer (arrow) in a patient with Barrett's esophagus. (From Wall, S.D., and Jones, B.: Gastrointestinal tract in the immunocompromised host: Opportunistic infections and other complications. Radiology, 185:327, 1992.)

Figure 4-6 Double-contrast esophagogram demonstrates multiple oval and linear filling defects (arrows), compatible with plaques due to Candida esophagitis. (From Jones, B., and Braver, J.M. (eds.): Essentials of Gastrointestinal Radiology. Philadelphia, W.B. Saunders, 1982.)

Figure 4-7 Double-contrast esophagogram demonstrates multiple intersecting linear and horizontal ulcers with intervening areas of edema, resulting in a shaggy, cobblestone appearance. This is severe candidal esophagitis. (From von Heuck, F.: Klinische Radiologie Diagnotik mit bildgebenden Verfahren. In von Fuchs, H.-F., and Donner, M.W. [eds.]: Gastrointestinaltrakt. Berlin, Springer-Verlag, 1990.)

Figure 4-8 Contrast esophagogram demonstrates a large ulcer (arrows) compatible with a CMV ulcer. An HIV ulcer could have an identical appearance. Endoscopy is necessary with biopsy to differentiate. (From Jones, B., and Braver, J.M. (eds.): Essentials of Gastrointestinal Radiology. Philadelphia, W.B. Saunders, 1982.)

Figure 4-9 Double-contrast upper GI series demonstrates a large hiatal hernia (HH) with minimal narrowing at the gastroesophageal junction. In the distal esophagus, there are many small collections of barium due to ulceration (arrows). This is an example of esophagitis. (From von Heuck, F.: Klinische Radiologie Diagnotik mit bildgebenden Verfahren. In von Fuchs, H.-F., and Donner, M.W. [eds.]: Gastrointesünaltrakt. Berlin, Springer-Verlag, 1990.)

Figure 4-10 Single-contrast esophagogram demonstrates a distal esophageal stricture (arrow) due to gastroesophageal reflux. There is also a small hiatal hernia (HH). (From Jones, B., Ravich, W.J., and Donner, M.V.: Dysphagia in systemic disease. Curr. Imaging, 3:158, 199.)

Figure 4-11 Double-contrast esophagogram demonstrates an acute esophagltls with a 1 cm ulcer (arrow). This was due to quinidine.

Figure 4-12 Single-contrast esophagogram In a patient taking ferrous sulfate demonstrates narrowing of the esophageal lumen and Intramural extention of contrast (arrows).

Figure 4-13 Double-contrast esophagogram demonstrates multiple flask-like outpouchlngs of the esophagus. This is actually filling of the submucosal glands. This is an example of intramural pseudodiverticulosis. (From von Heuck, F.: Klinische Radiologie Diagnotikmit bildgebenden Verfahren. In von Fuchs, H.-F., and Donner, M. W. [eds.J: Gastrointestinaltrakt Berlin, Springer-Verlag, 1990.)

Figure 4-14 Single-contrast esophagogram demonstrates a long smooth stricture involving the mid and distal esophagus with minimal dilatation of the upper esophagus. This Is a result of long-term nasogastric tube intubation.

Figure 4-15 Single-contrast esophagogram demonstrates a long, smooth stricture of the lower esophagus with tapered margins. This Is an example of a lye stricture. (From Jones, B., and Braver, J.M. (eds.): Essentials of Gastrointestinal Radiology. Philadelphia, W.B. Saunders, 1982.)

Figure 4-16 Single-contrast oblique view of the pharynx and upper esophagus demonstrating a thin horizontal linear filling defect on the anterior wall, compatible with a web. (From Taveras, J.M., and Ferrucci, J.T. [eds.J: Radiology Diagnosis: Imaging and Intervention. Volume 4. Philadelphia, J.B. Lippincott, 1992, p. 12.)

Figure 4-17 Spot films from videopharyngogram in the (A) frontal, (B) lateral, and (Cj oblique projections demonstrate a 4.5 x 3 x 4.5 cm Zenker's diverticulum (Z). This fills with contrast and is seen above the level of the crlcopharyngeus. Contrast within the diverticulum refluxes back Into the pharynx (arrows).

Figure 4-17 Spot films from videopharyngogram in the (A) frontal, (B) lateral, and (Cj oblique projections demonstrate a 4.5 x 3 x 4.5 cm Zenker's diverticulum (Z). This fills with contrast and is seen above the level of the crlcopharyngeus. Contrast within the diverticulum refluxes back Into the pharynx (arrows).

Figure 4-19 Single-contrast esophagogram demonstrates an epi phrenic diverticulum in the distal esophagus (arrow). (From von Heuck, F.: Klinische Radiologie Diagnoäk mit bildgebenden Verfahren. In von Fuchs, H.-F., and Donner, M.W. [eds.]: Gastrointestinaltrakt. Berlin, Springer-Verlag, 1990.)

Was this article helpful?

0 0
Natural Remedy For Yeast Infections

Natural Remedy For Yeast Infections

If you have ever had to put up with the misery of having a yeast infection, you will undoubtedly know just how much of a ‘bummer’ it is.

Get My Free Ebook


Post a comment