Transcript Gastrointestinal Radiology

Gastrointestinal
Radiology
Contrast media
Type of contrast media
– Barium sulfate
– Water soluble
สารทึบรังสีที่ใช้ ตรวจมี 2 ชนิด คือ
1. Barium sulfate
2. Water-soluble contrast agent
BARIUM SULFATE
WATER SOLUBLE
CONTRAST AGENT
Questions
• 1. The case in aspiration is
suspected, which contrast
medium is preferred?
• 2.The case in perforation is
suspected, which contrast
media is preferred?
TECHNIQUE
• การตรวจหาความผิดปกติของระบบทางเดินอาหาร
ด้ วย barium มี 2 วิธี คือ
• 1. SINGLE CONTRAST STUDY
• 2. DOUBLE CONTRAST STUDY
SINGLE
CONTRAST STUDY
SINGLE CONTRAST TECHNIQUE
DOUBLE
CONTRAST
STUDY
DOUBLE CONTRAST TECHNIQUE
PRINCIPLE
ความผิดปกติทพี่ บในภาพถ่ ายรังสี ของทางเดินอาหาร แบ่ งได้ เปน น
2 ประเภทดังนี้
1. ความผิดปกติที่เกิดจากพยาธิสภาพนอกทางเดินอาหาร
(Extrinsic lesion)
2. ความผิดปกติของระบบทางเดินอาหาร (Intrinsic lesion)
2.1 Protruded lesion ได้แก่ mucosal fold, polyp, tumor
และ varices เป็ นต้น
2.2 Depressed lesion ได้แก่ ulcer, diverticulum และ
perforation เป็ นต้น
Diagram
A
mucosal mass
B
submucosal or
intramural mass
C
extrinsic mass
Extrinsic lesion
ความผิดปกติท่ เี กิดจากพยาธิสภาพนอกทางเดินอาหาร
MASS
ความผิดปกติที่เกิดจากพยาธิสภาพนอกทางเดินอาหาร
ความผิดปกติที่เกิดจากพยาธิสภาพของทางเดินอาหาร: Protruded lesion
A
B
mucosal mass
Polyp
A
B
Diagram
submucosal or
intramural mass
ความผิดปกติท่ เี กิดจากพยาธิสภาพของทางเดินอาหาร:
Depressed lesion
A
B
C
En-face
Double
contrast
upright
Single
contrast
Profile
CARCINOMA
CARCINOMA (2)
CARCINOMA (3)
CARCINOMA (4)
CARCINOMA (5)
ESOPHGUS
ACHALASIA CARDIA
THORACIC DIVERTICULUM
• - Arises in the middle
third of the thoracic
esophagus
- Traction diverticulum
(arrow) that develops
in response to the
pull of fibrous
adhesion after
mediastinal lymph
node infection
or inflammation (star)
EPIPHRENIC DIVERTICULUM
• Arises in the distal of
the esophagus, just
above diaphragm
• Pulsion diverticulum
(arrow) that probably
related to
incoordination of
esophageal peristalsis
and relaxation of the
lower esophageal
sphincter
ESOPHAGEAL VARICES :
The characteristic radiographic appearance
1. Serpiginous filling defects which
appear as round or oval filling defects
resembling the beads of a rosary( dilated
venous structures) ( arrowhead).
2. Changes size and appearance with
variations in intrathoracic pressure and
collapse with esophageal peristalsis and
distension.
3. Varices related to portal
hypertension are most commonly
demonstrated in the lower third of the
esophagus.
4. In portal hypertension ; common
accompanying gastric varices(arrow).
Answer : CANDIDA ESOPHAGITIS
•
•
INFECTIOUS ESOPHAGITIS : Increasingly common because of the use of steroid
and cytotoxic drugs, disseminated malignancy, and increasing incidence of acquired
immunodeficiency syndrome
CANDIDA ESOPHAGITIS:
: Most common infectious disease of the esophagus
: Radiographic findings include
1. Abnormql esophageal motility ( dilated,
atonic esophagus ) is often an early stage
2. Irregular, nodular, plaque-like mucosal
pattern ( arrow), irregular folds(arrowhead)
with marginal serrations ( shaggy
appearance )
3. Multiple ulcerations of various sizes
4. Frequently involve the entire thoracic
esophagus
Esophagogram
Answer : CORROSIVE ESOPHAGITIS
•
•
•
Most severe corrosive injuries are caused by alkalis
Barium study is unnecessary during acute phase.
Radiographic findings;
1. Diffuse superficial or deep ulceration
involving long portion of the distal
esophagus
2. Abnormal motility
3. Fibrotic healing results in a long
esophageal stricture ( arrow) that
extends down to the cardioesophageal
junction.
Note : barium was aspirated into left main
bronchus(green arrow)
Major radiographic findings:
EARLY STAGE
- Flat plaque-like
lesion or small
polypoid
lesion) on one
wall of the
esophagus
: Major radiographic appearances (2) :
ADVANCED STAGE
•
A. Large Polypoid ( often
fungating ) filling defect
(arrow) with overhanging
edge (yellow arrow)
•
B. Large ulcer niche
(yellow
arrow) within a bulging
mass (ulcerated mass)
(arrow)
Major radiographic appearances (3)
•
Advanced stage
• A. Encircling mass with
irregular luminal
narrowing (green arrow)
and shelf like margins
(black arrow)
• B. Nodular thickened
folds (varicoid type)
(black arrow); Extension
of the tumor
(green arrow)
PSEUDO-ACHALASIA caused by direct spread to the
distal esophagus from gastric carcinoma
Radiographic findings :
1. Irregularly, narrowed and nodular(
arrowhead), sometimes ulcerated
(arrow), lesion at distal esophagus
2. Rapid transition between normal
and abnormal part.
3. Dilatation of proximal esophagus.
STOMACH
WHAT IS YOUR
DIAGNOSIS ?
Radiographic appearances of benign gastric ulcer (1)
1. Crater : Barium collection within the ulcer crater
• Profile view(A): Penetration of the ulcer projecting beyond the
normal barium-filled gastric lumen (arrow)
• En-face view(B): Round or oval barium collection on dependent
part (arrow)
Radiographic appearances of benign gastric ulcer (2)
• 2.1
Hampton’s line:
an approximately 1-2 mm
thin straight line (green
arrow)traversing the
orifice of the ulcer crater
(white arrow)
• On profile view represent
overhanging normal
gastric mucosa of
undermined ulcer
Radiographic appearances of benign gastric ulcer (3)
• 2.2 Ulcer collar :
• : smooth thick
lucent band (arrow)
interposed between
the ulcer crater
(star) and gastric
lumen (G)
• : represent
thickened rim of
edematousgastric
wall
Radiographic appearances of benign gastric ulcer (4)
Radiographic appearances of benign gastric ulcer
• 2.3 Ulcer mound:
smooth, sharply
delineated, gradually
sloping extensive
tissue mass (arrow)
surrounding the ulcer
(arrowhead)
• : represent severe
edematous gastric
wall
Radiographic appearances of benign gastric ulcer (5)
Radiographic appearances of benign gastric ulcer
3. Radiation of smooth thickened folds (arrow)
extending directly to the edge of the crater
(arrowhead) on profile view(A) and en-face view (B)
Radiographic appearances of benign gastric ulcer (6)
• 4. Incisula defect :smooth,
deep, narrow, sharp
indentation on greater
curvature(green arrow)
opposite a crater (white
arrow) on lesser curvature:
spastic contraction of
circular muscle
Chronic Duodenal Ulcer at duodenal bulb
• Duodenal Ulcer
•
•
•
•
•
: More than 95%
occur in the duodenal bulb
: Associated with H.
pylori infection in >95%
of cases
: Almost always
duodenal ulcers are benign
: Radiographic
appearances
1. Ulcer crater :
barium collection on
dependent part and airfilled with ring shadow on
nondependent part
Radiographic appearances: Duodenal Ulcer (1)
2. Thickened folds ( large
arrow)
3. Spasm and deformity
of the duodenal bulb
(small arrow)
• : barium collection in
the ulcer crater (green
arrow)
Radiographic appearances: Duodenal Ulcer (2)
4. Chronic duodenal ulcer : Deformity of the duodenal bulb from fibrotic healing
- Cloverleaf deformity (A) : symmetric narrowing of the midportion of the bulb
with dilatation of the inferior and superior recesses at the base of the bulb (arrow)
- Pseudodiverticulum (B) : asymmetric narrowing of the bulb
Answer : Duodenal Diverticulum
- Incidental finding in 5%of barium examination
bulb
stomach
• Most common
found along the
medial border of
the descending
duodenum at
periampullary
region
• Smooth rounded
shape with narrow
neck projecting
beyond the bowel
lumen (arrow)
Gastric Diverticulum
• Least common site of
GI diverticula
• Location :
- 75% at posterior wall
of fundus (arrow)
- Other location
:prepyloric area
Note : Pseudodiverticulum
from chronic duodenal
ulcer at duodenal bulb
(arrowhead)
Radiographic appearances : Gastric cancer
Polypoid mass
- Small polypoid mass in early
stage (arrow) may be
indistinguishable from benign
polyp
- Large polypoid carcinoma
appear as lobulated or
fungating masses
- Produce filling defect (arrow)
on barium study
Radiographic appearances : Gastric cancer (1)
Focal constricting lesion:
localized infiltrating
carcinoma or localized
scirrhous carcinoma
• Annular filling defect
(arrow)
Radiographic appearances : Gastric cancer (2)
fundus
bulb
antrum
body
Focal constricting
lesion
: localized infiltrating
carcinoma or localized
scirrhous carcinoma
- circumferential
irregular narrowing of
the lumen with
rigidity (as figure;
involved body and
antrum)
Radiographic appearances : Gastric cancer (3)
Linitis plastica pattern
- tumor invasion of the
gastric wall
- diffuse irregular
narrowing and rigidity
of the stomach
Gastric Carcinoma at antrum : malignant gastric ulcer
• 5% of gastric ulcers are malignant
• Radiographic appearances:
1. Intraluminal ulcer (not project
beyond the expected margin of the
stomach ) (arrow)
2. Irregular, nodular mass
(arrowhead) surrounding the
ulcer
3. Irregular or nodular thickened
folds that radiate to the mass
4. Carman meniscus sign :
semicircular or meniscoid ulcers
(arrow) with its inner margin
convex toward the lumen
Radiographic appearances : Gastric cancer (4)
• Ulcerated carcinoma
tumor mass
(arrowhead) has been
replaced by ulceration
(arrow)
Malignant ulcer from gastric leiomyosarcoma
• Tumor of smooth muscle of
GI tract
• Intramural in origin
• Radiographic appearances:
1. Intramural or submucosal
mass
(green arrow) : obtuse angle
with
the normal bowel wall (white
arrow)
2. Variable appearances:
intraluminal, exogastric
(extrinsic mass) or mixed form
3. Frequently ulceration
(black arrow)
COLON
Radiographic findings : Colonic Diverticulosis
• 1. Multiple round or oval
outpouchings of barium
projecting beyond the lumen on
profile view (white arrow),
barium collection (white
arrowhead) or ring-like lesion
(black arrowhead) on en-face
view
Radiographic findings : Colonic Diverticulosis
• 2. Criss-crossing ridges of
thickened circular muscle
(sawtooth configuration)
(arrow)
Polyp: focal, protruded lesion within the bowel including neoplastic
and non-neoplastic lesion
Morphologic Classification :
1. Sessile plaque : flat plaque and base wider than height
2. Sessile hemisphere : semilunar shape polyp and base slightly
wider than height
3. Pedunculated sphere : small round polyp with stalk
Colonic Carcinoma
• Annular Carcinoma
(green arrow) with
shelf-like margin
(black arrow)
Colonic Carcinoma
Polypoid Carcinoma
(arrow)
Tuberculous enterocolitis
• Ileocecal area (80-90%)
• Radiographic findings :
C
I
– 1. Irregular thickened bowel wall
(white arrow) resulting in narrowing of
the lumen (coned cecum)(C)
– 2. Thickened ileocecal valve
– 3. Wide gap of patulous ileocecal valve
(green arrow)
– 4. Thickened wall of terminal ileum (I)
– 5. Deep ulcer with/without sinus tract
or fistula