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Questions and Answers
What is the main purpose of the barium swallow procedure?
What is the main purpose of the barium swallow procedure?
How long is the cervical esophagus typically?
How long is the cervical esophagus typically?
What should patients do before undergoing the barium swallow procedure?
What should patients do before undergoing the barium swallow procedure?
Which anatomical structures cause impressions on the esophagus visible during a barium swallow?
Which anatomical structures cause impressions on the esophagus visible during a barium swallow?
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What is the typical size of the imaging receptor (IR) used during a barium swallow procedure?
What is the typical size of the imaging receptor (IR) used during a barium swallow procedure?
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What kind of view is primarily used to assess the upper and lower esophagus?
What kind of view is primarily used to assess the upper and lower esophagus?
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What is the appropriate range of kilovolts (KV) for the barium swallow procedure?
What is the appropriate range of kilovolts (KV) for the barium swallow procedure?
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What is the anatomical landmark below which the centering point is set for the AP view in a barium swallow?
What is the anatomical landmark below which the centering point is set for the AP view in a barium swallow?
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Which of the following is NOT a routine view taken during a barium swallow study?
Which of the following is NOT a routine view taken during a barium swallow study?
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What is the maximum length of the abdominal part of the esophagus?
What is the maximum length of the abdominal part of the esophagus?
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Study Notes
Barium Swallow
- A medical imaging procedure used to examine the upper gastrointestinal tract, including the esophagus and, to a lesser extent, the stomach.
- Barium sulfate is used as a contrast agent.
Anatomy of the Esophagus
- The esophagus begins at the upper esophageal sphincter (level of C6) and ends at the lower esophageal sphincter (level of T11).
- Approximately 25 cm long.
- Cervical esophagus: extends from the cricoid cartilage to the suprasternal notch, approximately 4-5 cm long.
- Thoracic esophagus: extends from the suprasternal notch (T1 level) to the diaphragmatic hiatus (T11 level), approximately 18 cm long.
- Abdominal esophagus: extends from the diaphragmatic hiatus to the cardiac orifice of the stomach, approximately 1 cm long.
- Anatomical constrictions:
- Superiorly: Level of the cricoid cartilage, where the esophagus meets the pharynx.
- Middle: Crossed by the aorta and left main bronchus.
- Inferiorly: Diaphragmatic sphincter.
Examinations of the Pharynx and Esophagus
- Barium sulfate is the typical contrast agent used in exams of the alimentary tract, unless otherwise contraindicated.
- Thin barium: useful for outlining the esophagus quickly; useful for diagnosing reflux (using water test, shallow LPO, compression, or toe-touch maneuver).
- Thick barium (barium paste): mixed with water; coats and adheres to the mucosa; often mixed with cotton balls, marshmallows, or other foods.
- No specific patient preparation usually needed for esophagram, unless it is to be followed by an upper gastrointestinal (UGI) series.
Patient Preparation
- Usually no need for pre-procedure preparations, unless there will be other parts of the GI tract studies.
- Patient is instructed to follow NPO (nothing per oral) before the procedure.
- Remove any jewelry.
- Ensure there are no contraindications to the pharmacologic agent used.
- Check for pregnancy.
- Explain the procedure to the patient before beginning.
Types of Contrast Studies
- Single contrast study
- Double contrast study
Esophagus Procedures
- Single contrast: involves multiple mouthfuls of 80% w/v barium suspension. Patient is placed prone and asked to swallow. Useful for assessing esophageal contractions, compression, displacement, and disordered motility.
- Double contrast: using high-density, low-viscosity barium (200-250%); 15-20 mL given and patient asked to swallow. Then effervescent powder is given with another mouthful of barium. Best position for this study is upright; gas tends to stay up and allows for adequate esophageal distension. Injection of buscopan IV is sometimes performed to keep the esophagus dilated for a longer period.
Barium Swallow - Technique
- Series of plain films or fluoroscopy to identify pathology.
- Patient positioned in an erect position.
- Ample mouthful of barium is swallowed, and spot films are taken rapidly.
- Spot films of the upper and lower esophagus are taken.
- Serial radiography sequences may be necessary.
Routine Views
- Anteroposterior (AP)/Posterioanterior (PA)
- Right Lateral
- Right anterior oblique (RAO) and Left anterior oblique (LAO)
Anteroposterior/Posteroanterior View
- Patient in supine or prone position.
- Collimating beam at both sides of the esophagus (about the width of a hand).
- Central ray at the level of D6 (about 5 cm below the sternal angle).
- Expose while patient swallows.
Lateral View
- Patient in lateral position while standing, with the midcoronal plane parallel to the bucky.
- Collimating beam at both sides of the esophagus (about the width of a hand).
- Central ray at the level of D6.
- Esophagus seen anterior to the dorsal spine.
Right Anterior Oblique/Left Posterior Oblique and Left Anterior Oblique/Right Posterior Oblique
- Patient in the midline, rotated 45 degrees to achieve oblique position.
- Esophagus appears clear of the spine.
- Collimating the beam (about the width of a hand).
- Central ray at C6 level.
Imaging Parameters
- IR size: 18x24 cm.
- Centering point: below the thyroid cartilage (AP), 2.5 cm below the thyroid cartilage (lateral/lat).
- kVp range: 100-110.
Barium Swallow - Typical Film Series
- Erect RAO (35-40 degrees): Esophagus between vertebral column and heart.
- Erect LAO: Esophagus between hilar region of lung and thoracic spine.
- Erect AP: Esophagus through superimposed thoracic vertebrae.
- Lateral: Entire esophagus between thoracic spine and heart.
Indications
- Dysphagia
- Heartburn, retrosternal pain, regurgitation, odynophagia
- Hiatus hernia
- Reflux esophagitis.
- Esophageal stricture.
- Esophageal carcinoma.
- Motility disorder (achalasia, diffuse esophageal spasm).
- Pressure or invasion from extrinsic lesions.
- Assessment of pharyngoesophageal junction abnormalities (Zenker's diverticulum, cricoid webs, cricopharyngeal achalasia).
Contraindications
- Suspected leakage from the esophagus into the mediastinum, pleura, or peritoneal cavities.
- Tracheo-esophageal fistula.
Complications
- Barium leakage from unsuspected perforation.
- Aspiration.
Specific Findings
- Carcinoma of the Esophagus (CA): Preferably high-viscosity, normal-density barium used. Classical finding is a "rat-tail" appearance.
- Achalasia: Barium swallow showing dilatation of the esophageal body, with a short-segment stricture, and a "bird-peak" like tapering at the gastroesophageal (GE) junction.
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Description
Explore the medical imaging procedure known as Barium Swallow, which is critical for examining the upper gastrointestinal tract. This quiz also covers the anatomy of the esophagus, detailing its structure, length, and anatomical constrictions. Test your knowledge on the esophagus and its role in digestion!
