1. Barium Studies For GIT Radiographic Anatomy & Pathology By
Dr Ma’moon Al-omari
Interventional & Diagnostic Radiologist
JUST

2. 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

3. 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

4. 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.

5. NG tube .. Chest tube … Normal anatomy
B.Swallow indication in child regargitation, in adult dysphagia

6. 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

7. Esophagus is narrow near the L. atrium  so in enlargement  dysphagia
Narrow esoph. Due to heart compression >>> achalasia
Hiatus part of diaphragm

8. 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

9. Normal anatomy .. The esophagus pass through the diaphragm in a hiatus
Esophageal ampulla

11. Longitudinal mucosa in the esophagus
there is a constriction : maybe normal ( if moving due to peristalsis ) or abnormal ( if constant )

12. Single contrast
fundus
body
antrum
Double contrast
B. Meal .. Incisora angularis ( arrow )

13. ((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

14. Ilium has no feathery
appearance (no plicea
circularis)
Indentration in jujenum ( plica circularis)

15. Plica circularis
Small bowel enema … use a catheter directly to the small intestine .. Tip of the cath ( arrow )

16. Ileocecal junction

17. ascending
cecum
Terminal ileum, because it is most common site of pathology we take special view for it
sigmoid
B. Enema single contrast

18. Rt lateral decubitus
Double contrast …. Position in R. side …
look at the haustrium

19. appendix
Double contrast

20. Double contrast

23. 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

24. 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

25. 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.

26. B. Swallow single contrast shows
Achalasia  bird peek or rat tail appearance

27. Lower Esophagus
achalasia
Stenosis is short sharp like the rat tail

28. 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

29. It shows an irregularity that almost looks like an apple core lesion in the esophagus. This is typical in carcinoma of the esophagus

30. Single contrast , irregular , tight , short, smooth>>> benign stricture
Tertiary contraction
Achalasia

31. Pharyngeal poutch
B. Swallow  poutch in cervical esophagus ( zinger diverticulum ) in criopharayngeal muscle >> aspiration pneumonia due to weak portion of pharyngeal wall

32. 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

33. Filling defect >>> varices

34. Contrast filled lesion in the stomach , speculated>> gastric ulcer

35. rugea
Contrast filled lesion in abnormal location …
gastric ulcer,,maybe malignant due it’s position

36. Contrast filling lesion in the duodenum(1st part) speculated  duodenal ulcer

37. Stomach
Speculated , contrast filled lesion , at the
first part of the deoudenum (star shape)

38. Single bobble … pyloric obstruction

39. Pyloric canal elongated >>> pyloric stenosis

40. 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.

41. 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.

42. 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.

43. Diverticulosis
Ascending colon
Sacculations (psudo-diverticulum) due to scaring & fibrosis

44. 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

45. Diverticulosis Contrast filled
Rectal tube

46. Diverticulosis
and abscess ( air fluid level )

47. Multiple polyposis
Malignant transformation
multiple small & round filing defect

48. Loss of haustraion  UC
Lead pipe sign >> UC
Wide terminal ileum

49. 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

50. Apple core appearance
Cecal carcinoma

51. Sigmoid stricture>> Sigmoid carcinoma
apple core appearance

52. Colon cancer
Apple core appearance

53. Sigmoid cancer in UC
Apple core appearance
Ddx: cancer, ischemia, IBD
Narrwing
Sigmoid
B.Enema

54. B. Enema
Indirect Inguinal hernia

55. Splenomegaly  deviated colon

56. Hurshsrung disease .. Rectosegmoidal (
short ) type
Dilated colon
note : toxic colon is C/I for barium
The distal part not dilated