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Questions and Answers
What is the primary purpose of a barium swallow procedure?
What is the primary purpose of a barium swallow procedure?
What is the length of the thoracic esophagus?
What is the length of the thoracic esophagus?
Before a barium swallow procedure, patients are generally advised to do what?
Before a barium swallow procedure, patients are generally advised to do what?
Which view is NOT typically used during a routine barium swallow examination?
Which view is NOT typically used during a routine barium swallow examination?
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What material is used as a contrast agent in a barium swallow procedure?
What material is used as a contrast agent in a barium swallow procedure?
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What anatomical structures can leave impressions on the esophagus as seen in a barium swallow?
What anatomical structures can leave impressions on the esophagus as seen in a barium swallow?
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What is the setting for the centering point in anteroposterior view for a barium swallow procedure?
What is the setting for the centering point in anteroposterior view for a barium swallow procedure?
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During the barium swallow procedure, the patient is typically positioned how?
During the barium swallow procedure, the patient is typically positioned how?
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How does the length of the abdominal part of the esophagus compare to other sections?
How does the length of the abdominal part of the esophagus compare to other sections?
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What is typically used to take spot films during the barium swallow procedure?
What is typically used to take spot films during the barium swallow procedure?
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Study Notes
Barium Swallow
- A medical imaging procedure examining the upper gastrointestinal tract (esophagus and, to a lesser extent, the stomach).
- Barium sulfate is used as a contrast agent.
Anatomy
-
Esophagus:
- Begins at the upper esophageal sphincter (C6) and ends at the lower esophageal sphincter (T11).
- Approximately 25 cm long.
- Three parts: cervical (4-5 cm), thoracic (18 cm), abdominal (1 cm).
- Cervical esophagus extends from the cricoid cartilage to the suprasternal notch.
- Thoracic esophagus extends from the suprasternal notch to the diaphragmatic hiatus.
- Abdominal esophagus extends from the diaphragmatic hiatus to the cardiac orifice of the stomach.
-
Constrictions of the Esophagus:
- Superiorly: level of cricoid cartilage, juncture with pharynx.
- Middle: crossed by aorta and left main bronchi.
- Inferiorly: diaphragmatic sphincter.
Examinations of the Pharynx and Esophagus
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Contrast Media:
- Barium sulfate is used, unless contraindicated.
- Thin barium outlines the esophagus quickly (used in upright position, emptying into stomach in seconds). Useful in diagnosing reflux.
- Thick barium (paste) is mixed with water and coats the mucosa. Often mixed with cotton balls, marshmallows, or foods.
Patient Preparation
- Usually no need for preparation unless more GIT studies are to follow.
- Patient must fast (NPO).
- Remove jewelry.
- Ensure no contraindications for pharmacological agents.
- Check for pregnancy.
- Explain procedure to the patient before starting the examination.
Types of Contrast Studies
- Single contrast study
- Double contrast study
Esophagus - Contrast Studies
-
Single Contrast:
- Multiple mouthfuls of 80% w/v barium suspension given.
- Patient placed prone for swallow assessment of esophageal contraction.
- Useful in identifying esophageal compression, displacement, or motility disorders.
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Double Contrast:
- Contrast high density, low viscosity (200-250%).
- 15-20 mL given, followed by effervescent powder and another mouthful of barium.
- Patient placed in an erect posture to increase adequate distension time for better visualization.
- Buscopan IV injection is given prior to the procedure to prolong upper esophageal distension.
Barium Swallow - Technique
- Series of plain films or fluoroscopy to find any pathology.
- Patient positioned erect.
- Ample mouthful of barium swallowed, rapid sequence spot films taken.
- Upper and lower esophagus spot films taken.
- May need rapid serial radiography sequences.
Routine Views
- Antero-posterior (AP),
- Right lateral view,
- Right anterior oblique (RAO),
- Left anterior oblique (LAO views).
Antero-posterior / Postero-anterior Views (AP/PA)
- Place patient supine or prone.
- Collimate beam at both sides of oesophagus (about hand width).
- Center ray at D6 level, (approx 5 cm below sternal angle).
- Expose during patient's swallow.
Lateral Views
- Patient positioned lateral, midcoronal plane parallel to the stand bucky.
- Collimate beam at both sides of esophagus (approximately hand-width).
- Center Ray at D6 level.
- Observe how the esophagus is seen.
Right Anterior Oblique/Left Posterior Oblique (RAO/LAO) & Left Anterior Oblique/Right Posterior Oblique (LAO/RAO)
- Patient in midline, rotated 45 degrees
- Collimate the beam approximately hand width.
- Central ray at C6 level.
Imaging Parameters
- IR size: 18x24 cm.
- Centering point: below thyroid cartilage.
- Lateral positioning: 2.5 cm below thyroid cartilage.
- kVp: 100 to 110.
Barium Swallow - Typical Film Series
- Erect RAO (35–40 degrees): Esophagus between vertebral column and heart.
- Erect LAO: Esophagus between hilar region and the thoracic spine.
- Erect AP: Esophagus through superimposed thoracic vertebrae.
- Lateral: Entire esophagus between the thoracic spine and heart.
Indications
- Dysphagia.
- Heartburn, retrosternal pain, regurgitation, odynophagia.
- Hiatus hernia.
- Reflux oesophagitis.
- Stricture formation.
- Esophageal carcinoma.
- Motility disorders (achalasia, diffuse esophageal spasms).
- Pressure or invasion from extrinsic lesions.
- Pharyngo-esophageal junction abnormalities (Zenker's diverticulum, cricoid webs).
- Cricopharyngeal achalasia.
Contraindications
- Suspected leakage from esophagus into the mediastinum or pleural and peritoneal cavities.
- Tracheo-esophageal fistula.
Complications
- Leakage of barium from unsuspected perforation.
- Aspiration.
Esophageal Carcinoma (Ca Esophagus)
- Preferably high viscosity, normal density barium used.
- Classical finding in carcinoma - rat-tail appearance.
Achalasia Cardia
- Barium swallow shows dilatation of the esophageal body.
- Short segment stricture.
- "Bird's peak" appearance at the gastroesophageal junction.
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Description
Explore the Barium Swallow procedure, a vital imaging test for examining the upper gastrointestinal tract. Understand the anatomy of the esophagus and its constrictions, as well as the use of barium sulfate as a contrast agent. Perfect for medical students and professionals interested in gastrointestinal imaging.
