BARIUM SWALLOW - TECHNIQUE | VARIANTS | PATHOLOGIES || DR SANJEEV MANI

Barium Swallow Study: Understanding the Procedure and Anatomy

Overview of Barium Swallow Studies

• The study of barium swallows is considered outdated but still performed occasionally, alongside other examinations like barium meals and follow-through studies.

• Acknowledgment is given to Dr. Surya Sabu, Dr. Rajesh Kamle, and Dr. Chandrasekhar Kingsley for their contributions to the tutorial images.

Symptoms Leading to Examination

• Patients typically present with dysphagia (difficulty swallowing), which may indicate esophageal strictures or obstructions.

• Important patient history includes weight loss, hematemesis (vomiting blood), and any post-operative status that could affect swallowing.

Anatomy of the Esophagus

• The esophagus is a flattened muscular tube extending from the cricoid cartilage at C6 to the cardiac orifice of the stomach at D11, divided into cervical, thoracic, and abdominal sections.

• Barium swallow studies focus on imaging from the oral cavity through to the stomach; sometimes replaced by upper GI series for broader examination.

Preparation for Barium Swallow

• Prior to administering barium, patients must fast overnight; initial steps include positioning them supine for fluoroscopic checks for aspiration or lesions in the chest.

• After administering a thick bolus while lying down, assess esophageal peristalsis to identify motility disorders.

Imaging Techniques During Examination

• Images are taken in oblique positions to avoid superimposition on the spine; this allows clearer visualization of esophageal structures during bolus administration.

• Three phases of imaging are essential: single contrast (full barium column), double contrast (with air), and mucosal phase (to observe vertical stripes indicating normal anatomy).

Normal Esophageal Constrictions

• Awareness of normal anatomical constrictions is crucial; these include indentations caused by structures such as the aortic arch and left main bronchus.

• The cricopharyngeal bar at C6 can indicate motility disorders if prominent; understanding these variations helps differentiate between normal anatomy and pathology.

Observing Motility Disorders

• Key structures observed during examination include lateral pharyngeal walls and pyriform sinuses using techniques like puffed cheek or modified Balsa maneuver for better mucosal visibility.

• Tertiary contractions seen in lying positions can suggest neuromuscular disorders; careful observation during fluoroscopy aids diagnosis.

This structured summary provides an organized overview of key concepts related to barium swallow studies based on the provided transcript. Each point links back to specific timestamps for easy reference.

Esophageal Pathologies and Imaging Insights

Overview of Esophageal Conditions

• The posterior aspect of the esophagus shows slight motility disorders, indicated by a green arrow. A shotsky ring is observed, which is a thin, smooth mucosal ring narrowing the gastroesophageal junction (GE Junction).

• A cervical esophagus film reveals a smooth outpouching filled with barium, identified as a Zenker diverticulum. This condition differs from achalasia and occurs due to congenital weakness in the cricopharyngeal muscle.

• Zenker's diverticulum is classified as a pulsion diverticulum that forms above the cricopharyngeus muscle and is associated with gastroesophageal reflux and hiatal hernia.

Types of Diverticula

• Lateral pharyngeal pouches or pharyngocele are noted on either side of the pharynx; these are typically asymptomatic and found in trumpet players. They result from mucosal protrusion through the thyroid hyoid membrane.

• A large hiatal hernia occupies the retrocardiac space, visible on an oblique view filled with barium. An air-fluid level may also be present in this area.

Achalasia: Characteristics and Implications

• The lower esophagus displays significant dilation characteristic of achalasia, marked by tapering at the distal end when sphincter closure occurs. This motor disorder usually affects individuals aged 30 to 50 years.

• Achalasia results from dysfunction of the lower esophageal sphincter leading to incomplete relaxation and elevated resting pressure, causing food buildup and potential aspiration pneumonitis.

Differentiating Primary from Secondary Achalasia

• Secondary achalasia can mimic primary cases but arises from gastric conditions affecting the GE junction. It should be considered in older patients presenting acute symptoms or showing mucosal nodularity on imaging.

Esophageal Webs and Associated Syndromes

• An esophageal web appears as shelf-like lucency in imaging studies; it may only be visible with large boluses of barium.

• Esophageal webs are linked to Plummer-Vinson syndrome, often seen in patients suffering from chronic iron deficiency anemia.

Other Types of Diverticula

• Additional types include epiphrenic diverticula located just above the GE junction and traction diverticula typically associated with tuberculosis or lung lesions pulling on the esophagus.

Strictures: Presentation Variability

• Strictures can vary significantly; they may present as smooth or irregular mucosa along with possible esophageal dilation depending on growth rates of underlying cancers.

• Long segment strictures may appear smooth but require further investigation via endoscopy to rule out malignancy; rapid growth can lead to less noticeable dilation compared to slower-growing lesions.

Esophageal Conditions and Imaging Insights

Esophageal Dilatation and Lesion Growth

• The esophagus may exhibit a "rat tail" appearance due to dilatation, which is influenced by the growth rate of lesions. Slow-growing lesions allow for more significant dilatation compared to fast-growing ones.

• Subtle mid-esophageal dilation can be overlooked; careful examination reveals mucosal irregularities that may indicate early-stage conditions, such as esophageal cancer.

Corrosive Ingestion and Its Effects

• Corrosive ingestion is a prevalent form of poisoning affecting the GI tract, particularly in children (accidental) and adults (suicidal). It primarily damages the oropharynx, esophagus, and stomach.

• Both acidic and alkaline corrosives have similar impacts on the GI tract, leading to potential long-term morbidity rather than immediate mortality.

Radiological Findings in Esophageal Disorders

• Barium studies reveal various abnormalities in the esophagus, including smooth concentric narrowing or a beaded appearance extending towards the stomach.

• Tight strictures can lead to proximal esophageal dilatation and barium retention in upper segments. Subtle lesions must not be missed during examinations as they can indicate serious underlying issues.