X-ray signs of pathology

of the digestive system

Diseases of the esophagus
Developmental anomalies of the esophagus
Anomalies first discovered in adults include mild
circular or membrane narrowing of the
esophagus, congenital short esophagus with
formation of a pectoral stomach, and congenital
esophageal cysts.
Stenosis. X-ray examination: uniform narrowing of
the lumen of the esophagus, usually in the middle
third of the thoracic region, with a slight
suprastenotic expansion; the contours of the
contraction are smooth, elasticity is preserved; in
the membranous form, the triangular retraction is
located asymmetrically.
Esophageal stenosis
Diverticula - protrusion of the mucous membrane with or without
submucosal layers. In accordance with the location, they are
divided into pharyngeal-esophageal (Tsenker), bifurcational,
epiphrenal. Depending on the mechanism of occurrence,
pulsational, traction and mixed.
Displacement of the esophagus
X-ray examination: the aberrant right subclavian artery (a.
Lusoria) passes through the posterior mediastinum and forms an
impression on the esophagus in the form of a strip-like defect
running obliquely.
The right-sided aortic arch forms impressed not on the esophagus
along the posterior-right wall. Enlarged lymph nodes of the
posterior mediastinum (metastases, lymphosarcoma,
lymphogranulomatosis) form an impression on one of the walls
of the esophagus or push it back
Functional disorders of the esophagus
Hypotension
X-ray examination: revealed by filling the piriform
sinuses and pharyngeal vallecules; the thoracic
esophagus is dilated, the contrast mass is retained
in it.
Hypertension (secondary, tertiary contractions and
segmental spasm)
X-ray examination: secondary contractions (spasm of
the middle third of the thoracic esophagus in the
form of an "hourglass") tertiary contractions
(uneven retraction of the esophageal walls,
serration) due to non-peristaltic anarchic
contractions of the esophagus. Segmental spasm is
a contraction in the lower thoracic esophagus.
Cardiospasm (esophageal achalasia)
X-ray examination: on the plain chest X-ray - expansion of the
shadow of the mediastinum to the right; when contrasting - a
relatively uniform expansion of the esophagus along its entire
length, conical narrowing of the abdominal esophagus, food in
the esophagus, impaired contractile function of the esophagus,
absence of a gas bubble in the stomach, thickening of the folds
of the esophageal mucosa
Esophageal burns
X-ray examination: in the acute period, water-soluble contrast agents
are used; on the 5-6th day after the burn are determined
signs of necrotizing ulcerative esophagitis (thickening and tortuous
course of folds of the mucous membrane, ulcerative "niches" of various
sizes, mucus); with the development of cicatricial complications,
persistent narrowings are formed in the form of an "hourglass" or a
narrow tube; above the constriction, suprastenotic expansion is
determined; the contours of the narrowing are even, the transition to the
unaffected part is gradual
Intraluminal benign tumors (polyps)
X-ray examination: round or oval filling defect
with clear contours; if there is a leg, then the
tumor may be displaced; peristalsis at the
tumor level is not disturbed; a large tumor
causes a spindle-shaped expansion of the
esophagus, the contrast mass flows around the
tumor on the sides; folds of the mucous
membrane are flattened, preserved; there is no
suprastenotic expansion.
Esophageal carcinoma
Endophytic, or infiltrative, form of cancer
X-ray examination: at the initial stage it looks
like a small rigid area on the esophagus
contour; as the tumor grows, the narrowing
becomes circular, until the esophagus is
completely obstructed; the wall at the level of
the constriction is rigid (no peristalsis); folds
of the mucous membrane are rearranged,
destroyed - "malignant" relief of the mucous
membrane; pronounced suprastenotic
expansion
Exophytic, or polyposis, form of cancer
X-ray examination: intraluminal filling defect
with bumpy contours; when the tumor is
circular, a "cancerous canal" is formed with an
irregular, broken and uneven lumen; folds of the
mucous membrane are destroyed, peristalsis at
the tumor level is absent; the transition to the
unaffected area is sharp, step-like, with a break
in the contour; pronounced suprastenotic
expansion.
DISEASES OF THE STOMACH
Functional diseases
Atony (hypotension) of the stomach
X-ray examination: the barium suspension falls down
accumulates in the sinus, increasing the transverse siz
of the stomach; the stomach is elongated; the gas
bubble is elongated; the gatekeeper gapes; peristalsis
is weakened, gastric emptying is slowed down
Increased stomach tone
X-ray of the stomach. Stomach atony
X-ray examination: the stomach is reduced,
peristalsis is increased, the gas bubble is short,
wide; barium suspension lingers for a long time in
the upper parts of the stomach; the gatekeeper is
often spasmodic, sometimes gaping
Inflammatory and destructive diseases
Acute gastritis
X-ray examination: thickening and indistinctness of the
folds of the mucous membrane; violations of the motor
and evacuation functions of the stomach. With erosive
gastritis, the folds of the mucous membrane are pillow-
shaped,
Chronic gastritis can manifest itself in various
morphological changes.
on some of them, depressions in the center with an
accumulation of barium suspension in them are
determined.
Chronic gastritis can manifest itself in various
morphological changes.
on some of them, depressions in the center with
an accumulation of barium suspension in them
are determined.
X-ray examination: thickening and indistinctness
of the folds of the mucous membrane with
significant dysfunction of the stomach. In case of
lip-like (warty) gastritis, uneven warty eminences
of various shapes are determined on the gastric
mucosa with "anastomosing" of the folds of the
mucous membrane.
In chronic atrophic gastritis, the mucous
membrane is thinned, the folds are smoothed;
the stomach is hypotonic. With antral rigid
(sclerosing) gastritis, uneven thickening of the
folds of the mucous membrane of the antrum,
jagged contours, rigidity of the walls of the
outlet of the stomach are determined
Stomach ulcer
X-ray examination reveals direct (morphological) and
indirect (functional) signs.
Direct X-ray signs of gastric ulcer are a symptom of a
"niche" and cicatricial ulcerative deformity.
Niche - X-ray display of an ulcer defect in the wall of a
hollow organ and a marginal shaft around. It is found in
the form of a protrusion on the contour (contour-niche)
or a contrasting spot against the background of the
relief of the mucous membrane
A large niche can have a three-layer structure (barium,
liquid, gas). The contour niche is usually geometrically
correct, conical. Its contours are clear, even, the shaft is
symmetrical. In the edge-forming position, the niche
protrudes beyond the contour of the stomach and is
separated from it by a narrow band of enlightenment -
the Hampton line. The relief-niche is rounded, with
smooth, even edges. It is surrounded by an inflammatory
shaft, to which the folds of the mucous membrane
converge
Penetrating ulcer of irregular shape, its contours are
uneven, containing three layers. Barium suspension
lingers in it for a long time due to the significant
densification of tissues around.
Indirect signs of an ulcer are a violation of the tonic,
secretory and motor-evacuation function of the stomach
and duodenum. There are also concomitant gastritis and
local tenderness.
Perforated (perforated) ulcer is manifested by free gas
and fluid in the peritoneal cavity.
TUMORS OF THE STOMACH
Benign tumors
Gastric polyps can be single or multiple.
X-ray examination: the central filling defect of the
correct rounded shape with clear, even or fine-wavy
contours; in the presence of a leg, the filling defect is
easily displaced; the mucosal relief is not changed; wall
elasticity and peristalsis are not disturbed (Fig. 10.44).
With malignancy of the polyp, its shape changes, the leg
disappears, the contours and wall rigidity appear.
Malignant tumors
Endophytic tumors

X-ray examination: deformation and narrowing of the

lumen of the stomach with circular tumor growth;
with limited wall infiltration - a flat concave filling
defect, rigid; on the border with an unaffected area, a
step is determined, a sharp break in the contour; the
folds of the mucous membrane are rigid, motionless
("frozen waves"), sometimes they are smoothed and
not traceable
Exophytic tumors
X-ray examination: the leading X-ray symptom is a
marginal or central filling defect of an irregular rounded
shape with wavy uneven contours, roughly bumpy, in the
form of "cauliflower"; at the transition of the tumor to a
healthy wall, a ledge or step is formed; surface. X-ray of
the stomach tumor has an atypical “malignancy.
Endophytic carcinoma of the body, gastric »relief of the
mucous membrane; on the border with the unaffected area,
a break in the folds of the mucous membrane is visible; at
the level of the affected area, the stomach wall is rigid,
elasticity is absent
Enteritis
X-ray examination: pronounced functional
disorders in the form of dyskinesia and
dystonia; swelling of the folds of the mucous
membrane (symptom of "mottling"); gas and
liquid in the lumen of the intestine, forming
horizontal levels
Crohn's disease
It is often detected in the terminal section of the small intestine in
combination with the defeat of the large intestine.

X-ray examination: when contrasting the intestines through the mouth and
with the help of a contrast enema, the main X-ray sign is a pronounced
narrowing of the intestine in a limited area; residual elasticity of the intestine
is preserved; the contour of the constriction is jagged due to ulcers protruding
onto it; interintestinal and external fistulas are often detected; mucous
membrane, altered like "paving stones" or "cobblestones"; the transition from
the affected area to a healthy one is gradual
Chronic ulcerative colitis
X-ray examination: restructuring of the mucous
membrane to and in the form of thickened edematous
pseudopolyposic folds, narrowing of the intestinal
lumen, flattening or absence of haustration, decreased
elasticity of the walls
INTESTINAL TUMORS Benign tumors

X-ray examination: when contrasting the intestine, a clear

rounded filling defect with even contours is revealed,
sometimes shifting towards the peristaltic wave; folds of the
mucous membrane are spread on it or smoothly "flow
around" it; the elasticity of the wall is not compromised;
there is no suprastenotic enlargement
Malignant tumors
Endophytic tumors
X-ray examination: at the tumor level,
persistent narrowing of the intestinal lumen
with uneven contours; the transition from the
narrowed area to the unaffected area is sharp,
in the small intestine with collar
intussusception; folds of the mucous
membrane in the affected area are not traced;
intestinal wall is rigid
Exophytic tumors

X-ray examination:
lumpy, irregularly shaped filling defect, protruding
into the lumen of the intestine; has a wide base; there
is no peristalsis at this level; the surface of the tumor
is uneven, folds of the mucosa form a "malignant
relief" or are absent; the intestinal lumen at the level
of the filling defect is narrowed, sometimes there is a
suprastenotic expansion