GI Studies
38 Esophagus
Anatomy
mouth, pharynx, esophagus, stomach, esophagogastric junction, cardiac antrum.
Projections
[Part], PA or AP
CR Location
[Part], PA or AP –
Evaluation Criteria
RAO Image Criteria: Esophagus seen midway between heart and T-spine. Arms out of the way. Entire esophagus filled with barium.
Lateral Image Criteria: Esophagus seen midway between heart and T-spine. Superimposition of posterior ribs (true lateral). Arms out of the way. Entire esophagus filled with barium.
AP (PA) Image Criteria: No rotation of the body (how do we know this?). Entire esophagus filled with barium.
LAO Image Criteria: Esophagus seen midway between hilar region of lungs and T-spine. Arms out of the way. Entire esophagus filled with barium.
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Hows & Whys of Esophagus Radiography
- What are the boundaries of the oral cavity?
- The oral cavity is bounded by the teeth, hard and soft palates, and tongue.
- What is the medical term for chewing?
- The medical term for chewing is mastication.
- What is the medical term for chewing?
- The medical term for swallowing is mastication.
- Where does the oral cavity connect posteriorly?
- The oral cavity connects to the pharynx posteriorly.
- At what level does the pharynx transition into the esophagus?
- The pharynx transitions into the esophagus at the level of C6.
- Where are the indentations of the esophagus located?
- There are 2 indentations in the esophagus one at the aortic arch and one where the esophagus crosses the left primary bronchus.
- What is the esophageal hiatus, and at what level does the esophagus pass through it?
- The esophageal hiatus is the hole in the diaphragm through which the esophagus passes, located at the level of T10.
- What is the cardiac antrum?
- The cardiac antrum is the part of the esophagus below the diaphragm.
- Where does the esophagus join the stomach, and what is this opening called?
- The esophagus joins the stomach at the esophagogastric junction, located at the level of T11.
- What types of contrast media are used in an esophagram?
- Positive contrast media (radioopaque, such as barium sulfate) and sometimes negative contrast media (radiolucent, such as air formed by gas crystals).
- Who performs the fluoroscopy during an esophagram?
- The radiologist performs the fluoroscopy while the technologist assists the patient.
- What are the common indications for an esophagram?
- Indications include:
- Anatomical anomalies (e.g., birth defects or disease-related structural issues)
- Foreign body obstruction
- Esophageal reflux
- Esophageal varices (varicose veins in the esophagus)
- Indications include:
- Are there any contraindications to an esophagram?
- There are no major contraindications. Allergies to barium sulfate are extremely rare, but allergies to the coloring or flavoring may occur.
- When might water-soluble contrast be used instead of barium?
- Water-soluble contrast (e.g., Gastrografin) may be used if the patient has had recent surgery or is at risk of perforation.
- What allergies should be checked if using water-soluble contrast?
- Check for allergies to iodine, seafood, table salt, or x-ray dye.
- Is there any special preparation for the patient before an esophagram?
- No preparation is required unless the patient is also having an upper GI series to follow.
- Why is the RAO position usually preferred over the LAO position?
- The RAO position provides more visibility of pertinent anatomy than does the LAO.
- What is the medical term for swallowing?
- Deglutition.
- What is the valsalva maneuver?
- Bearing down like you are having a bowel movement.
- What does the valsalva maneuver do?
- It increases intra-abdominal and intra-thoracic pressures which may cause esophageal reflux.
- What is positive contrast?
- Radioopaque material that shows up white on images, like barium or hypaque.
- What is negative contrast?
- Radiolucent material that shows up black on images, like air.