IMAGE CRITIQUE & EVALUATION

GASTRO-INTESTINAL CONTRAST
STUDIES

DR YAHUZA MANSUR ADAMU

BAYERO UNIVERSITY KANO.
2024
 CONTRAST AGENTS IN GIT STUDIES
• BARIUM SULPHATE
– An inert powder that is reconstituted into a suspension with
water
– The most common oral contrast used in GIT
– It is contraindicated in the ff
• When there is suspicion of bowel perforation
• When there is a likelihood of aspiration of barium into the lungs
• In the presence of complete bowel obstruction
• WATER SOLUBLE CONTRAST MEDIA
– Eg, Gastrograffin
– Indicated when
• when there is suspicion of bowel perforation
• In the presence of complete bowel obstruction
 GIT CONTRAST STUDIES
• BARIUM SWALLOW (pharynx & OESOPHAGUS)
– Indications: dysphagia, oesophageal reflux, oesophageal
cancer
• BARIUM MEAL (stomach)
– Indications: dyspepsia, epigastric pain or mass
• SMALL BOWEL FOLLOW THROUGH (Ileum)
– Indications: for the visualisation of small bowel lesions from
the duodeno-jejunal junction to the ileocaecal valve, such
as inflammatory or neoplastic lesions
• BARIUM ENEMA (rectum, colon, terminal
ileum/appendix)
– Indications: assessment of strictures, masses, polyps.
NORMAL BARIUM SWALLOW

OESOPHAGUS
NORMAL DOUBLE CONTRAST
BARIUM MEAL
GASTRIC FUNDUS
DISTAL OESOPHAGUS

LESSER
CURVATURE

1ST PART OF
DUODENUM

2ND PART OF
GREATER
DUODENUM
CURVATURE
GASTRIC
ANTRUM
NORMAL BARIUM MEAL FOLLOW THROUGH
EXAMINATION OF THE SMALL BOWEL
STOMACH

SMALL BOWEL LOOPS

 NORMAL BARIUM ENEMA OF THE
LARGE BOWEL (COLON)
TRANSVERSE COLON

DESCENDING
COLON
ASCENDING
COLON

RECTUM
 GASTRO INTESTINAL TRACT PATTERNS
• OESOPHAGEAL PATTERNS
– Oesophageal ulcer
• Causes: candida infection commonly found in immunosuppressed
patients (AIDS, patients on steroid or cytotoxic drugs) and
malnourished children
• Ulcers: longitudinal, deep punched out, large or perforating ulcers.
– Oesophageal narrowing:
• Corrosive oesophagitis, from caustic soda ingestion
• Oesophageal carcinoma, irregular strictures usually with proximal
shouldering.
• Benign oesophageal stricture: usually following reflux oesophagitis,
smooth stricture
– Oesophageal varices:
• Multiple vertical serpiginous mucosal filling defects
 LATERAL BARIUM SWALLOW:
OESOPHAGEAL CARCINOMA WITH PROXIMAL OBSTRUCTION
SHOULDERING

shouldering

IRREGULAR OESOPHAGEAL NARROWING

 BARIUM SWALLOW:
OESOPHAGEAL VARICES
Multiple vertical serpiginous mucosal filling defects
 GASTRO INTESTINAL TRACT PATTERNS
• STOMACH PATTERNS
– STOMACH MASS
• Single gastric mass: polyp, leiomyoma, carcinoma, bezoar
• Multiple gastric masses: polyps, fundal varices, gastric cancer,
lymphomas, metastasis
• Masses are identified as filling defects on barium meal
– THICKENED MUCOSAL FOLDS
• Gastric rugae >1cm in diam. are considered to be enlarged or thickened
• Causes: inflammatory (Zollinger Ellison syndrome), tumours
(Lymphoma, adenocarcinoma)
– GASTRIC ULCERS
• More common on the lesser curve and antrum
• Appear as collections of barium outside the line of the stomach lumen
MASSES ON BARIUM MEAL:
Identified as filling defects
 BARIUM MEAL:
Lesser curve ulcer crater
 GASTRO INTESTINAL TRACT PATTERNS
• SMALL BOWEL PATTERN
– SB pattern is best visualised on barium follow through:
– SMALL BOWEL STRICTURE
• Can be single or multiple
• Causes: fibrous adhesions from previous surgery, inflammatory
(TB enteritis or Crohn’s disease, commonly involving the
terminal ileum), lymphoma, radiation stricture
– SMALL BOWEL FOLD THICKENING
• Causes: Ischaemia, oedema (hypoprotenaemia), inflammatory
(TB, crohn’s dx), infiltrative diseases (metastasis, lymphoma)
– NODULAR SMALL BOWEL PATTERN
• Causes: small bowel lymphoma, nodular lymphoid hyperplasia.
 BARIUM ENEMA
Ileocaecal TB: conical shape caecum, circumferential
narrowing and deep ulcer in the terminal ileum

caecum

Terminal ileum
GASTRO INTESTINAL TRACT PATTERNS
COLONIC PATTERN
– CARCINOMA OF THE COLON
• Presents as either as a mass or polyp, or focal circumferential
narrowing
• If there is “shouldering” at either end of the stricture an APPLE
CORE lesion
• Polyps appear as filling defects in a pool of barium, or as a soft
tissue mass density if coated with barium
– COLONIC THUMB-PRINTING
• Usually due to oedematous or ischaemic colonic mucosa
• It is found in amoebiasis, ischaemic colitis, crohn’s disease,
ulcerative colitis
– DIVERTICULAR DISEASE
• These are out-pouches of the mucosa and submucosa through the
hypertrophied smooth muscle in the colonic wall
 BARIUM ENEMA
Transverse colon carcinoma: apple core
circumferential narrowing of the colon.
shouldering

Apple core
deformity

shouldering
 BARIUM ENEMA
Ulcerated polyp in the sigmoid colon
 BARIUM ENEMA
Thumb printing appearance in amoebic colitis
 BARIUM ENEMA
Diverticular disease of the descending and sigmoid
colon
• THANK YOU