Professional Documents
Culture Documents
Barium Swallow
Barium Swallow
SWALLOW
DR. SANDRA JOHNS
JR MDRD
• Barium swallow is the non invasive contrast procedure used in
assessing the anatomy, physiology & pathology of upper GI tract
including esophagus & GE junction.
• Barium has superior contrast qualities and unless there are specific
contraindications, its use (rather than water-soluble agents) is
preferred.
BARIUM SULPHATE - 250% OF HIGH DENSITY LOW
VISCOSITY
Indications: Complications:
• 1. Suspected perforation. Pulmonary edema if aspirated,
• 2. Suspected fistula.
not with LOCM
Hypovolemia in children,
• 3. History of recent biopsy. May precipitate in hyperchlorhydric
• 4. Suspected Lower Intestinal obstruction. gastric acid,
• 5. Corrosive poisoning. Allergic reactions – due to absorbed
contrast media
• 6. Meconium ileus/plug syndrome.
• 7. Immediate post operation status
Equipment's Patient preparation
• Rapid serial radiography or
cineradiography (2 frames • NPO for 4 hours
per second), or • Avoid smoking
• Video recording, or
• 100 mm roll films.
TECHNIQ
UE
A. Single contrast swallow :
• Position – RAO
• Patient is asked to take a
mouthful of barium and initial
screening is done as it passes
along the whole length of
esophagus to note any gross
lesion.
PHARYNGOESOPHAGEAL
EVALUATION :
• So best is to use Low osmolal Contrast Media and if not then little
amount of barium.
3. MOTILITY
DISORDER :
• Swallow in lying down position
Siphon test. Fill the stomach with 50% Table is kept in head down position.
Barium (150-200 ml). Follow this with 1-2
mouthfuls of water to remove traces of barium Patient is first placed in Lt decubitus and
in the oesophagus. Make the patient supine then turned supine; which causes Barium to
with left side raised 15 up. Keep one mouthful accumulate in fundus of stomach. Patient is
of water in the patients mouth. Ask the patient then slowly turned to Right causing Barium
to swallow the water-a jet of barium will shoot in fundus to pour over Cardia;during this
into the water column as it enters the G.O. maneuver reflux may be seen.
junction. Abdominal compression can also be given to
help precipitate reflux and using a DC
technique.
Air-contrast esophagram shows thick esophageal mucosal folds (arrows)
and an ulcer (arrowhead) due to GERD.
Single contrast esophagram shows stricture (arrow) and sliding hiatus
hernia
On the left Irregular stricture (arrowhead) and erosions (arrows) due to
GERD.
Barrett's esophagus with reticular mucosa and web-like (arrow) stricture
On the left a patient with a Barrett's esophagus with an adenocarcinoma.
There are abnormal distal mucosal folds.
The upper margin of adenocarcinoma makes right angle with esophageal
wall (arrow) indicating a mural lesion in patient with GERD and Barrett's
esophagus.
Infectious esophagitis
Candida esophagitis
On the left a patient with an
infectious esophagitis due to
candida.
The barium study shows
numerous fine erosions and
small plaques due to Candida
albicans in
immunocompromised patient.
Cytomegalovirus esophagitis
an AIDS patient with an infectious
esophagitis due to Cytomegalovirus.
Such giant ulcers can also be due to
HIV alone.
Crohn's esophagitis
On the left a patient with
Crohn's disease.
There is a granulomatous
esophagitis with aphthous
ulcers (arrows).
This is an uncommon
manifestation of Crohn's
disease.
The figure on the right shows
the more common colonic
aphthous ulcers.
TB esophagitis
a patient with an infectious
esophagitis due to primary TB.
There is an irregular sinus tract
from proximal esophagus (arrow).
Chest radiograph shows enlarged
lymph nodes widening
mediastinum due to primary
tuberculosis.
Pseudodiverticulosis
Dilated mural glands or
pseudodiverticulosis, is usually
associated with histologic or
endoscopic signs of inflammation, and
many patients have strictures due to
GERD.
On the left a patient with esophageal
pseudodiverticulosis.
Hiatus :
.
• Patient has to strain.
On the far left a stricture (arrow) with irregular mucosal folds at stricture site on
air-contrast view.
This patient had Barrett's esophagus.
Mid esophageal strictures and ulcers are suspicious for Barrett's esophagus.
The two images on the right show a Barrett's esophagus with an irregular
stricture due to adenocarcinoma.
symmetric tapered benign stricture months after
radiotherapy.
images of a patient with a benign stricture high in
the esophagus (arrow).
There is bilateral lower lobe lung consolidation due
to repeated aspiration.
a high stricture (arrow) following caustic
ingestion
On the left a patient with benign pemphigoid.
Mucosal bullae have led to multiple strictures
(arrows).
Thank you