Gastrointestina

l Radiology
 Contrast media
Type of contrast media
–Barium sulfate
–Water soluble
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

• 1. SINGLE CONTRAST STUDY

• 2. DOUBLE CONTRAST STUDY
 SINGLE
CONTRAST STUDY
SINGLE CONTRAST TECHNIQUE
 DOUBLE
CONTRAST
STUDY
DOUBLE CONTRAST TECHNIQUE
 PRINCIPLE
1. (Extrinsic lesion)
2. (Intrinsic lesion)
2.1 Protruded lesion ,mucosal fold,
polyp, tumor , varices
2.2 Depressed lesion , diverticulum ,
perforation
 Diagram

A B C
extrinsic mass
mucosal mass submucosal or
intramural mass
Extrinsic lesion

MASS
 ี่ ดจากพยาธิสภาพนอกทางเดิน
ความผิดปกติทเกิ
อาหาร
 Protruded lesion

A B mucosal mass
Polyp

A B
Diagram

submucosal or
intramural mass
Depressed lesion

A Double
contrast

B upright

C Single
contrast
E n-face Profile
CARCINOMA
CARCINOMA (2)
CARCINOMA (3)
CARCINOMA (4)
CARCINOMA (5)
E SOP HAGUS
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.
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
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 air-
filled 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
 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

• Most common
bulb found along the
medial border of
the descending
duodenum at
stom periampullary
ach 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
- S mall polypoid
mass in early
stage (arrow) may
be
indistinguishable
from benign polyp
- Large polypoid
carcinoma appear
as lobulated or
fungating masses
Radiographic appearances : Gastric cancer (1)

Focal constricting lesion:

localized infiltrating
carcinoma or localized
scirrhous carcinoma

• Annular filling defect

(arrow)
 Radiographic appearances : Gastric cancer (2)
Focal constricting
lesion
fundus : localized infiltrating
carcinoma or localized
scirrhous carcinoma
- circumferential
bulb antrum body 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
R adiographic 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
R adiographic findings :
Colonic Diverticulosis
• 1. Multiple round
or oval
outpouchings of
barium projecting
beyond the lumen
on profile view
(white arrow),
barium collection
 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
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 :
– 1. Irregular thickened bowel wall
C (white arrow) resulting in narrowing of
the lumen (coned cecum)(C)
– 2. Thickened ileocecal valve
– 3. Wide gap of patulous ileocecal valve
(green arrow)
I – 4. Thickened wall of terminal ileum (I)
– 5. Deep ulcer with/without sinus tract
or fistula