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Barium Studies For GIT Radiographic Anatomy & Pathology By
Dr Ma’moon Al-omari Interventional & Diagnostic Radiologist JUST
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Objectives To describe different types barium studies
To know indications and contra indications To differentiate between different studies To know major radiographic anatomy Describe radiographic signs To give D.Dx
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Barium study barium swallow :esophagus
barium meal :stomach and duodenum barium through: small intestine barium enema : large intestine 1.Barium swallow the esophagus continuation for hypo pharynx start at level c5 there are impression or indentation : 1. cricopharyngeal muscle (impression posteriorly) 2.anteriorly : cricoids cartilage of larynx and there are a 3. small impression venous plexus
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The most common indication in adult dysphagia in children reflex GERD - B. swallow is studied by lateral view … esophagus starts at level of C5 “ where the cricopharyngeal muscle (impression posterioly) Above the muscle is the pharynx , below it the esoph.
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NG tube .. Chest tube … Normal anatomy
B.Swallow indication in child regargitation, in adult dysphagia
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anatomy ) and double ( for mucosa and
pathology ) constriction as left side : first by aortic arch and L. main bronchi at write : R. main bronchi Double contrast (pathology) Arch of aorta Left main bronchus Single contrast(anatomy) limited use usually use it for children
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Esophagus is narrow near the L. atrium so in enlargement dysphagia
Narrow esoph. Due to heart compression >>> achalasia Hiatus part of diaphragm
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Note: In thorax if there is gas is left main bronchus , but if there is no gas it is aortic arch
Gas>>left main bronchus Left main bronchus
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Normal anatomy .. The esophagus pass through the diaphragm in a hiatus
Esophageal ampulla
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Longitudinal mucosa in the esophagus
there is a constriction : maybe normal ( if moving due to peristalsis ) or abnormal ( if constant )
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Single contrast fundus body antrum Double contrast B. Meal .. Incisora angularis ( arrow )
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((The Suspensory muscle of duodenum or Ligament of Treitz (named after Václav Treitz) connects the
Deudenal cap duodenum of the small intestines to the diaphragm. If not in it’s anatomical place malrotation )) upright position jeju ileum
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Ilium has no feathery appearance (no plicea circularis) Indentration in jujenum ( plica circularis)
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Plica circularis Small bowel enema … use a catheter directly to the small intestine .. Tip of the cath ( arrow )
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Ileocecal junction
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ascending cecum Terminal ileum, because it is most common site of pathology we take special view for it sigmoid B. Enema single contrast
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Rt lateral decubitus Double contrast …. Position in R. side … look at the haustrium
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appendix Double contrast
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Double contrast
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When is single contrast preferred. 1
When is single contrast preferred ? 1. children ;since we don’t need mucosal pattern demonstartion 2. large obstructing lesion is suspected 3. intussusception – diagnostic and therapeutic
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Indications of double contrast : - to detect polyps and colorectal cancer - follow up screening for postoperative colorectal cancer - evaluation of diverticular disease - inflammatory bowel disease ; eg monitoring progress of ulcerative colitis - failed colonoscopy - evaluation of questionable findings on other imaging examinations such as CT scanning - investigation of non- specific abdominal pain, unexplained weight loss, anemia or altered bowel habits
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Contraindications : absolute : Toxic megacolon
- Pseudo- Toxic megacolon - Pseudomembraneous colitis - Rectal biopsy via: Rigid endoscope 5 day Flexible endoscope 24 membraneous relative : - Incomplete bowel preparation - Recent barium meal – wait for 7-10 days - Uncooperative patient.
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B. Swallow single contrast shows
Achalasia bird peek or rat tail appearance
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Lower Esophagus achalasia Stenosis is short sharp like the rat tail
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Long stenosis irregular with filling defect …
Long stenosis irregular with filling defect …. It shows an irregularity that almost looks like an apple core lesion in the esophagus. This is typical in carcinoma of the esophagus
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It shows an irregularity that almost looks like an apple core lesion in the esophagus. This is typical in carcinoma of the esophagus
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Single contrast , irregular , tight , short, smooth>>> benign stricture
Tertiary contraction Achalasia
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Pharyngeal poutch B. Swallow poutch in cervical esophagus ( zinger diverticulum ) in criopharayngeal muscle >> aspiration pneumonia due to weak portion of pharyngeal wall
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Varices Barium swallow examination: AP view:
Numerous rounded and elongated smooth-contoured filling defects(there is filling defect and contrast filled you should know but here is filling) are present in the inferior two thirds of the esophagus. The contour of the esophagus is irregular and spiculated. DDX : tumors , varicose , cron’s disease , HIV , food particles
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Filling defect >>> varices
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Contrast filled lesion in the stomach , speculated>> gastric ulcer
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rugea Contrast filled lesion in abnormal location … gastric ulcer,,maybe malignant due it’s position
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Contrast filling lesion in the duodenum(1st part) speculated duodenal ulcer
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Stomach Speculated , contrast filled lesion , at the first part of the deoudenum (star shape)
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Single bobble … pyloric obstruction
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Pyloric canal elongated >>> pyloric stenosis
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There is a short segment of
abnormal descending colon with asymmetrical puckering of the mucosal surface, without stricturing. Skip lesion>> cron’s Multiple narrowing Note also however that contrast has refluxed into the terminal ileum and small bowel, and there are several strictures present within it. One of these lies adjacent to the large bowel abnormality.
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Cecum Narrow terminal ilieum : DDX : cancer , CD, adhesion , TB , infection , ischemia, ileal atresia, lymphoma, histoplasmosis There is smooth narrowing of the terminal ileum and an adjacent loop of more proximal ileum as it crosses to the right side of the pelvis. There is no visible mucosal fold thickening or ulceration.
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Rose thorn ulcer>> CD
Cecum Cubblestone appearance : in CD … There is abnormal wall thickening, luminal narrowing, and cobblestoning involving a long segment of the distal ileum including the terminal ileum.
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Diverticulosis Ascending colon Sacculations (psudo-diverticulum) due to scaring & fibrosis
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complication of Diverticulosis : 1. fistula 2. diverticulitis 3
complication of Diverticulosis : 1. fistula 2.diverticulitis 3.hemorrhage 4.perotoinitis 5.perforation 6.obstruction 7.abcess Diverticulosis
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Diverticulosis Contrast filled
Rectal tube
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Diverticulosis and abscess ( air fluid level )
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Multiple polyposis Malignant transformation multiple small & round filing defect
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Loss of haustraion UC Lead pipe sign >> UC Wide terminal ileum
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Splenic flexure Granular mucosa and complete absence of haustra which confirm total colitis. 2 short strictures are present in the descending colon, but there were no malignant features radiologically UC ( granular mucosa) Rose thorn ulcer
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Apple core appearance Cecal carcinoma
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Sigmoid stricture>> Sigmoid carcinoma
apple core appearance
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Colon cancer Apple core appearance
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Sigmoid cancer in UC Apple core appearance Ddx: cancer, ischemia, IBD Narrwing Sigmoid B.Enema
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B. Enema Indirect Inguinal hernia
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Splenomegaly deviated colon
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Hurshsrung disease .. Rectosegmoidal (
short ) type Dilated colon note : toxic colon is C/I for barium The distal part not dilated
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