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BARIUM SWALLOW
1
BARIUM SWALLOW
• It is a medical imaging procedure used to examine
upper gastrointestinal tract,which include the
esophagu...
Anatomy
The oesophagus begins at the upper
oesophageal sphincter at the level of C6 and
finishes at lower oesophageal sphi...
CONSTRICTIONS
• superiorly: level of Cricoid
cartilage, juncture with
pharynx
• Middle: crossed by aorta and
left main bro...
SPHINCTERS
Two high pressure zones prevent the backflow of food:
• Upper Esophageal sphincter.
• Lower Esophageal sphincte...
CONTRAST
• TYPES OF CONTRAST STUDY
(i) SINGLE CONTRAST STUDY
(ii) DOUBLE CONTRAST STUDY
CONTRAST USED
• 100% BARIUM SULPHATE PASTE
• 80% BARIUM SULPHATE SUSPENSION
• 30% BARIUM SULPHATE SUSPENSION FOR HIGH KV T...
INDICATIONS
• Dysphagia
• Heart burn, retrosternal pain, regurgitation & odynophagia.
• Hiatus hernia
• Reflux oesophagiti...
CONTRAINDICATIONS
• Suspected leakage from esophagus into the
mediastinum or pleura and peritoneal cavities.
• Tracheo-eso...
VIEWS
• SOFT TISSUE NECK – AP & LAT – SCOUT
• NECK-AP & LATERAL
• THORAX-RAO VIEW
NORMAL-AP /LAT VIEW - SCOUT
RIGHT
ANTERIOR
OBLIQUE VIEW
Patient Preparation
TECHNIQUE
• PHARYNX
• -One mouthful contrast bolus with high density(250% w/v).
• -Patient is asked to swallow once and st...
• ESOPHAGUS
• Single contrast
• -Multiple mouthful 80% w/v barium suspension
given.
• -prone swallow to assess esophageal ...
• Double contrast
• -Contrast high density,low viscosity(200-250%).
• -15-20 ml given & asked to swallow.
• -Then efferves...
SPECIFIC CONDITIONS
ESOPHAGEA
L WEB
1) May be demonstrated on high-
volume barium oesophagrams when
the oesophagus is fully distended .
2)a "j...
oesophageal web
More commonly occur in the cervical oesophagus near
cricopharyngeus muscle than in the thoracic oesophagus...
Foreign Body Impaction
• To detect the level of
obstruction in case of
radiolucent foreign
body in
esophagus,marsh
mellow ...
• Barium swallow
shows irregular
areas of narrowing
and dilatation -----
“Shish kebab”
“corkscrew”
“rosary bead"
esophagus...
CA
ESOPHAGUS
• Preferably high viscosity with normal
density barium is used.
• Classical finding in carcinoma –rat tail
ap...
ACHALASIA
CARDIA
• Barium swallow showing dilatation of the
esophageal body
*With short segment stricture.
* A “bird-peak ...
HIATUS
HERNIA
• High abdominal pressure is required to demonstrate.
• Pt has to strain.
• Lie down,straighten legs & then ...
Barium meal in Trendlenberg position.
Displacement of the cardio-esophageal
junction above the esophageal hiatus .
Part of...
ESOPHAGEA
L VARICES
• Varices are best demonstrated in
mucosal relief study after using
Buscopan/ valsalva maneuver.
• Mild dilatation of the esophagus
with multiple persistent filling defects in the lower third
of the esophagus and/or lon...
Gastro esophageal reflux
• SIPHON TEST
• Fill the stomach with 50% barium(150-200ml)
• Follow this 1-2 mouthful of water t...
Oesophageal reflux
• Reflux oesophagitis with
a deep ulcer (straight
arrow). There is also
asymmetric narrowing of
the dis...
Barrett’s oesophagus
• The reticular mucosa
is characteristic of
Barrett's columnar
metaplasia, especially
with the associ...
Zenker’s Diverticulum
• A Zenker's diverticulum is a pulsion
hypopharyngeal false diverticulum
with only mucosa and submuc...
KILLIAN JAMIESON DIVERTICULUM
• Killian-Jamieson diverticulum is a pulsion diverticulum, that
protrudes through a lateral ...
Candida esophagitis
Shaggy esophagus
associated with Candida
infection , image "A"
depicts the longitudinally
oriented pla...
Candida Esophagitis
Candida Esophagitis :
-In immunocompromised patients
-Discrete plaque-like lesions
-Larger plaques may...
• Herpes , double-contrast
esophagram shows small
discrete ulcers (arrows) in the
midesophagus on a normal
background muco...
Cytomegalovirus
esophagitis
Cytomegalovirus esophagitis in a
patient with AIDS
Double-contrast esophagram
shows a large fl...
AIDS patient with an
infectious esophagitis
due to
Cytomegalovirus. ,
such giant ulcers can
also be due to HIV
alone
Drug induced esophagitis has variable
appearances depending on the culprit.
Antibiotics such as tetracycline and
doxycycli...
Feline
oesophagus
The folds are 1-2 mm thick and run horizontally
around the entire circumference of the
oseophageal lumen...
FELINE OESOPHAGUS
Feline oesophagus also known as oesophageal shiver, refers to the
transient transverse bands seen in the...
Eosinophilic
esophagitis
• small calibre oesophagus.
• transient or fixed circular
rings are seen.
Schatzki rings
Single-contrast solid barium swallows
(especially in the RAO prone position) are
more sensitive than endosc...
Schatzki rings
A Schatzki ring, also called Schatzki-Gary ring, is symptomatically narrow
oesophageal B-ring occurring in ...
Dysphagia lusoria
The oesophagus may be
compressed by a
congenitally aberrant right
subclavian artery.
If this is symptoma...
COMPLICATION
• Leakage of barium
from unsuspected
perforation
COMPLICATION
ASPIRATION
–
Dr.Varsha
“THANK YOU”
Barium swallow,,
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Barium swallow,,

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Barium swallow,,

  1. 1. BARIUM SWALLOW 1
  2. 2. 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.
  3. 3. Anatomy The oesophagus begins at the upper oesophageal sphincter at the level of C6 and finishes at lower oesophageal sphincter at T11 and is approx 25 cm.
  4. 4. CONSTRICTIONS • superiorly: level of Cricoid cartilage, juncture with pharynx • Middle: crossed by aorta and left main bronchi • Inferiorly: diaphragmatic sphincter
  5. 5. SPHINCTERS 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.
  6. 6. CONTRAST • TYPES OF CONTRAST STUDY (i) SINGLE CONTRAST STUDY (ii) DOUBLE CONTRAST STUDY
  7. 7. 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
  8. 8. INDICATIONS • 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.
  9. 9. CONTRAINDICATIONS • Suspected leakage from esophagus into the mediastinum or pleura and peritoneal cavities. • Tracheo-esophageal fistula
  10. 10. VIEWS • SOFT TISSUE NECK – AP & LAT – SCOUT • NECK-AP & LATERAL • THORAX-RAO VIEW
  11. 11. NORMAL-AP /LAT VIEW - SCOUT
  12. 12. RIGHT ANTERIOR OBLIQUE VIEW
  13. 13. Patient Preparation
  14. 14. 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.
  15. 15. • 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.
  16. 16. • 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.
  17. 17. SPECIFIC CONDITIONS
  18. 18. ESOPHAGEA L WEB 1) May be demonstrated on high- volume barium oesophagrams when the oesophagus is fully distended . 2)a "jet effect" of contrast passing distal to the web may be seen .
  19. 19. oesophageal web More commonly occur in the cervical oesophagus near cricopharyngeus muscle than in the thoracic oesophagus. They typically arise from the anterior wall and never from the posterior wall; they can also be circumferential. Associations • Plummer-Vinson syndrome • GvHD • GORD/GERD (especially a distal oesophagus web) • external beam radiation.
  20. 20. 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
  21. 21. • Barium swallow shows irregular areas of narrowing and dilatation ----- “Shish kebab” “corkscrew” “rosary bead" esophagus The esophageal muscle is hypertrophied, but histologically normal Diffuse oesophageal spasm
  22. 22. CA ESOPHAGUS • Preferably high viscosity with normal density barium is used. • Classical finding in carcinoma –rat tail appearance
  23. 23. ACHALASIA 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.
  24. 24. 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.
  25. 25. 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
  26. 26. ESOPHAGEA L VARICES • Varices are best demonstrated in mucosal relief study after using Buscopan/ valsalva maneuver.
  27. 27. • Mild dilatation of the esophagus with multiple persistent filling defects in the lower third of the esophagus and/or longitudinal furrows.
  28. 28. 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
  29. 29. Oesophageal 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.
  30. 30. Barrett’s oesophagus • The reticular mucosa is characteristic of Barrett's columnar metaplasia, especially with the associated web-like (arrow) stricture.
  31. 31. Zenker’s Diverticulum • A Zenker's diverticulum is a pulsion hypopharyngeal false diverticulum with only mucosa and submucosa protruding through triangular posterior wall weak site (Killian's dehiscence) between horizontal and oblique components of cricopharyngeus muscle. • The esophagram shows collection with midline posterior origin just above cricopharyngeus protruding lateral, usually to left, and caudal with enlargement
  32. 32. 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.
  33. 33. Candida esophagitis Shaggy esophagus associated with Candida infection , image "A" depicts the longitudinally oriented plaque-like lesions visible in Candida esophagitis , image "B" depicts the granular appearance of the esophageal mucosa secondary to edema and inflammation
  34. 34. Candida Esophagitis Candida Esophagitis : -In immunocompromised patients -Discrete plaque-like lesions -Larger plaques may coalesce to produce "cobblestone" appearance -Ulcers invariably appear only on a background of diffuse plaque formation , not as isolated findings -Further coalescence produces (shaggy) contour
  35. 35. • Herpes , double-contrast esophagram shows small discrete ulcers (arrows) in the midesophagus on a normal background mucosa , note the radiolucent mounds of edema surrounding the ulcers , in the appropriate clinical setting , this appearance is highly suggestive of herpes esophagitis since ulceration in candidiasis almost always occurs on a background of diffuse plaque formation .
  36. 36. Cytomegalovirus esophagitis Cytomegalovirus esophagitis in a patient with AIDS Double-contrast esophagram shows a large flat ulcer in profile (large arrows) in the midesophagus with a cluster of small satellite ulcers (small arrows)
  37. 37. AIDS patient with an infectious esophagitis due to Cytomegalovirus. , such giant ulcers can also be due to HIV alone
  38. 38. Drug induced esophagitis has variable appearances depending on the culprit. Antibiotics such as tetracycline and doxycycline tend to cause small shallow ulcers. potassium chloride and alendronate are more injurious and can lead to large ulcers and strictures. Radiation and caustic oesophagitis are usually suggested by history, both tend to produce long strictures and predispose to squamous cell carcinoma.
  39. 39. Feline oesophagus The folds are 1-2 mm thick and run horizontally around the entire circumference of the oseophageal lumen. The folds are angled with respect to centre of oesophagus in a HERRING BONE pattern.
  40. 40. FELINE OESOPHAGUS Feline oesophagus also known as oesophageal shiver, refers to the transient transverse bands seen in the mid and lower oesophagus on a double contrast barium swallow. The appearance is almost always associated with active gastro oesophageal reflux and is thought to be due to contraction of the muscularis mucosae with resultant shortening of the oesophagus and 'bunching up' of the mucosa in the lumen .
  41. 41. Eosinophilic esophagitis • small calibre oesophagus. • transient or fixed circular rings are seen.
  42. 42. Schatzki rings Single-contrast solid barium swallows (especially in the RAO prone position) are more sensitive than endoscopy in detecting Schatzki rings . On barium swallow the following features may be seen; • full-column barium swallow will reveal a circumferential narrowing at the gastro- oesophageal junction, often a few centimeters above the diaphragmatic hiatus • thin smooth ring, 2-4 mm • double contrast studies are less sensitive • performing a Valsalva manoeuvre may improve sensitivity • barium-tablet or barium-coated marshmallow may also improve sensitivity
  43. 43. Schatzki rings A Schatzki ring, also called Schatzki-Gary ring, is symptomatically narrow oesophageal B-ring occurring in the distal oesophagus and usually associated with a hiatus hernia. Depending on its luminal diameter, an oesophageal B-ring may be symptomatic or asymptomatic 4: • <13 mm: almost always symptomatic • 13-20 mm: sometimes symptomatic • >20 mm: rarely symptomatic When it is symptomatic, it is termed a "Schatzki ring".
  44. 44. Dysphagia lusoria The oesophagus may be compressed by a congenitally aberrant right subclavian artery. If this is symptomatic a diagnosis of dysphagia lusoria is made Here it is seen as oblique tubular extrinsic compression in upper oesophagus.
  45. 45. COMPLICATION • Leakage of barium from unsuspected perforation
  46. 46. COMPLICATION ASPIRATION
  47. 47. – Dr.Varsha “THANK YOU”

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