Esophagus: Spectrum of pathologies on Barium Swallow
Poster No.:
C-1426
Congress:
ECR 2013
Type:
Educational Exhibit
Authors:
E. Dhamija , D. Chandan , D. Srivastava ; New Delhi/IN, New
Delhi, DELHI/IN
Keywords:
Pathology, Dynamic swallowing studies, Fluoroscopy,
Conventional radiography, Gastrointestinal tract
DOI:
10.1594/ecr2013/C-1426
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Learning objectives
Barium Radiology has been largely replaced by newer techniques like endosccopy,
manometry,etc.
The purpose of this exhibit is to review the role of Barium study/Swallow in diagnosing
esophageal diseases.
To enumerate and illustrate various pathological findings on barium swallow
Background
Although endoscopy is a valuable test for evaluation of esophageal pathologies, Barium
swallow excels over it in evaluation of motility disorders, sub mucosal lesions and extrinsic
pathology.
Barium study also remains a helpful tool for patients with equivocal or uncertain findings
on endoscopy and CT.
Normal anatomy:
Esophagus
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Muscular tube 20-24 cm in length
Lined by stratified squamous epithelium
Outer longitudinal and inner circular muscle fibers
Striated muscle in upper third
rd
Smooth muscle in distal 2/3
Upper esophageal sphincter
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At pharyngo esophageal junction
Formed primarily by cricopharyngeus
Lower esophageal sphincter
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Defined by manometric evidence of high resting tone or pressure
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Images for this section:
Fig. 1: Normal esophageal anatomy
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Fig. 2
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Imaging findings OR Procedure details
Barium swallow is performed using low density Barium when passage of the bolus is
monitored under guidance of Flouroscopy.
Single and Double contrast imaging are advisable for the study as Double contrast
optimizes visualization of mucosa and single contrast optimizes esophageal distension
Duplication cyst
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Location-usually thoracic esophagus
Barium swallow shows a large extrinsic impression
CECT fluid-attenuating cystic structure
Carcinoma esophagus:
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Terminology-Squamous cell carcinoma and Adenocarcinoma: in Barrett
mucosa
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Imaging Findings- Barium Swallow
Best diagnostic clue: Fixed irregular narrowing of lumen
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Infiltrating, polypoid, ulcerative, varicoid lesions
Plaque-like lesions; flat, sessile polyps
Asymmetric contour with abrupt proximal borders (shouldering) and
narrowed distal segment (rat-tail appearance)
Differential Diagnoses-Inflammatory stricture Intramural primary
esophageal tumor
Esophageal web:
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Circumferential radiolucent ring
Commonly in proximal cervical oesophagus
Jet phenomena
D/D:Oesophageal stricture /Schatzki ring / Cricopharangeal achalasia
Post corrosive stricture:
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Diffuse long segmental narrowing-Thread like /Filiform appearance
Non distensible rigid esophagus
Extensive ulceration
Double Barreled appearance
CT-Diffuse esophageal wall thickening> 5 mm
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Target sign, pneumomediastinum, pleural effusion
D/D:Reflux oesophagitis,Infectious oesophagitis, oesophageal ca
Achalasia:
Primary oesophageal motility disorder characterized by hypertensive LOS which fails to
relax on swallowing.
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Markedly dilated oesophagus
Absent primary peristalsis
Bird Beak deformity
D/D:Scleroderma,Oesophageal ca, Gastric ca
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CT - To exclude secondary mass
Sliding hernia:
Lower oesophageal ring observed 2 cm or more above diaphragmatic hiatus
Diverticulum:
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Barium filled tented or triangular outpouching
Tends to empty in collapsed oesophagus
D/D:Oesophageal perforation,Oesophageal ulcer
Epiphrenic diverticulum- These pulsion diverticula are classified by their
location near the diaphragm. They can narrow the esophagus or lead to
aspiration, if large in size.
CMV Esophagitis:
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Occurs primarily in patients with AIDS.
manifest as multiple small ulcers or one or more giant #at ulcers on doublecontrast studies
Tertiary Contractions:
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non-propulsive, transient, and intermittent contractions
Inconstant in location
Usually in older patients.
Images for this section:
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Fig. 6: Significantly dilated esophagus with abrupt tapering at the level of GE junction
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Fig. 4: Irregular luminal narrowing with mucosal irregularity involving lower esophagus.
Note dilated proximal esophagus and shouldering of the segment proximal to stricture
Fig. 3: Barium swallow show extrinsic mass effect on thoracic esophagus. Contrast
enhanced CT scan shows presence of well defined cystic mass posterior to esophagus
Fig. 5: Radioluncent ring in cervical esophagus
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Fig. 7: Bird beak deformity at the level of lower esophageal sphincter and GE junction
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Fig. 8: Diverticulum seen as contrast filled outpouching from lower esophagus
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Fig. 9: Large ephiphrenic diverticulum
Fig. 10: Multiple small ulcerations in a HIV positive patient presenting with dysphagia
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Conclusion
Barium study in esophageal pathologies still holds its place in evaluation of mucosal
disease, submucosal pathologies and motility disorders.
It also serves as helping tool in uncertain findings.
References
1.
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3.
Marc S. Levine, MD, Stephen E. Rubesin, MD; Diseases of the
Esophagus:Diagnosis with Esophagography; Radiology 2005; 237:414-427
Pia Luedtke,BA, Marc S. Levine,MD, Stephen E. Rubesin,MD, Donald S.
Weinstein,MD,Igor Laufer,MD; Radiologic Diagnosis of Benign Esophageal
Strictures: A Pattern Approach; RadioGraphics 2003; 23:897-909
Marc S. Levine,MD, Stephen E. Rubesin,MD, Igor Laufer,MD; Barium
Studies in Modern Radiology: Do They Have a Role? Radiology 2009;
250:18-22
Personal Information
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