University of Mosul�College of Medicine
Lecture: ( 1a)
Subject/year: 2023-2024
Lecturer: Dalal Ahmed Ramadhan
Department: surgery
Date: 29-11-2023
GIT radiology
What is peculiar about GIT characteristics:
• Hallow viscus ( not solid).
• Usually filled with gas.
• Motility.
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Barium swallow �normal esophagus
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Barium swallow is a dedicated test of the pharynx, esophagus, and proximal stomach, and may be performed as a single or double contrast study.
Presentation
Chest pain & Dysphagia in 60 y male
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The bird's beak sign of the esophagus is used to refer to the tapering of the inferior esophagus in achalasia.
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Rat tail sign of the esophagus is used to refer to the tapering of the inferior esophagus in achalasia cardia .
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Achalasia cardia(primary achalasia)
1.Plain radiograph
Chest radiograph findings include:
convex opacity overlapping the right mediastinum. Occasionally may present as a left convex opacity if the thoracic aorta is tortuous.
air-fluid level due to stasis in a thoracic esophagus filled with retained secretions and food
small or absent gastric bubble
anterior displacement and bowing of the trachea on the lateral view
patchy alveolar opacities, usually bilateral, may be seen. These represent acute pneumonitis or chronic aspiration pneumonia related to dysphagia.
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2.Fluoroscopy with barium swallow
Findings include:
1.bird beak sign or rat tail sign at the distal aspect of the esophagus
2.esophageal dilatation occurs secondary to infra diaphragmatic lower third esophageal lumen narrowing being constant , variable in length & smooth in outline .
3.uncoordinated,non-propulsive, tertiary contractions .
4. No any shoulder sign .
Achalasia cardia
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A corkscrew esophagus
also known as a rosary bead esophagus, is a classic appearance of distal esophageal spasm on a barium swallow.
The finding is caused by multiple tertiary (non-propulsive) contractions interrupting the normal peristalsis.
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The appearance of the esophagus below is typical of what disease
Process ????
Chagas' disease
Scleroderma
Diffuse esophageal spasms
Achalasia
Achalasia cardia (CT scan) �CT scan of the chest ,coronal section shows: huge dilatation of the thoracic esophagus filled with food & fluid material , with narrowing of infra-diaphramatic portion of the esophagus.
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Esophageal stricture
refers to any persistent intrinsic narrowing of the esophagus.
Etiology
The most common causes are fibrosis induced by inflammatory , caustic material , post surgical and neoplastic processes.
Radiographic features
Benign strictures characteristically:
Long segment of constant narrowing smoothly tapering
Funneling of the proximal end
typically concentric narrowing, but may affect only one side of the .
esophagus (asymmetric wall rigidity)
Malignant strictures are characteristically:
abrupt
asymmetric
eccentric with irregular, nodular mucosa
Shoulder sign on either ends of the narrowing ( Apple core sign ) .
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Corrosive esophagitis
Barium swallow study:
Radiological finding :The esophagus is opacified with the contrast showing long segment of stricture involving the distal lower third part of the esophagus with proximal esophageal dilatation the narrowing is smooth in outline with funneling of the proximal end & no shoulder sign .
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Barium swallow study:
Radiological finding :The esophagus is opacified with the contrast showing long segment of stricture involving the mid & lower third part of the esophagus , & no shoulder sign .
DX:Corrosive esophagitis
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Barium swallow
Radiological finding: Moderate length lower esophageal stricture with irregular mucosa and shouldering of either end.
DX : Esophageal carcinoma
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CT scan Assessment of Esophageal Cancer: very important in Preoperative Staging and Monitoring of Response to Therapy
circumferential mural thickening of the lower thoracic esophagus
A ? B ?
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PET Scan: esophageal Ca
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Esophageal diverticula :
Radiological features: an outpouching from the wall of the esophagus seen filled with contrast
Upper esophageal diverticula
Zenker diverticulum: actually, pharyngeal but it is common practice to include it with esophageal , seen posteriorly in the cervical esophagus.
diverticula Killian-Jamieson diverticulum
Middle esophageal diverticula
Traction diverticula: are (true diverticula) which occur secondary to scarring, fibrosis and inflammatory processes (tuberculous adenitis)
a traction diverticulum is triangular or polygonal in shape, and broad-mouthed . Due to pulling on the esophageal wall , seen usually laterally.
Lower esophageal diverticula
epiphrenic diverticula: just above the diaphragm .
Traction diverticula
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Radiological features: an outpouching from the wall of the esophagus is seen, filled with contrast �
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Radiological features: an outpouching from the wall of the esophagus seen filled with contrast (mention the site & type)�
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Esophageal web
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