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Computed Tomography Enterography

Computed Tomography Enterography: How It Differs From Routine Abdominal Computed Tomography Computed tomography enterography (CTE) reflects individualization of the abdominal pelvic CT technique for patients with small bowel disorders. CTE provides visualization of the small bowel lumen, wall, and perienteric tissues by distending the small bowel with large volumes of oral contrast and obtaining multiplanar, high-resolution images of the bowel during appropriate phase(s) of enhancement. It…

Barium Studies of the Small Bowel

Normal Small Intestine The small intestine is extremely tortuous, beginning at the pylorus and extending about 11 feet in the living human from the pylorus to the ileocecal valve. Intestinal length is extremely variable, depending on neuromuscular tone and vascular flow. For example, the denervated, bloodless intestine stretched at autopsy varies from 10 to 30 feet in length. A patient with a small bowel obstruction will…

Postoperative Stomach and Duodenum

Gastroduodenal surgery is often performed for severe peptic ulcer disease (PUD), benign or malignant neoplasms, and obesity. Radiologic evaluation of the postoperative stomach and duodenum requires an understanding of the surgery performed, expected postoperative appearances, and potential complications. During the early postoperative period, the radiologist is often asked to evaluate the surgical anatomy and to assess for complications such as leaks. During the late postoperative period,…

Miscellaneous Abnormalities of the Stomach and Duodenum

Gastric Varices Pathophysiology Portal Hypertension The gastric fundus is normally drained by numerous short gastric veins that anastomose distally with the splenic vein and proximally with the coronary vein and venous channels surrounding the distal esophagus. The short gastric veins normally empty via the splenic vein into the portal vein. In portal hypertension, however, increased pressure in the portal and splenic veins leads to reversal of…

Other Malignant Tumors of the Stomach and Duodenum

Metastases Gastric and duodenal metastases are found at autopsy in less than 2% of patients who die of carcinoma. Most of them are blood-borne metastases, but the stomach and duodenum are also involved by lymphatic spread or by direct extension of tumor from neighboring structures or mesenteric reflections such as the gastrocolic ligament, transverse mesocolon, and greater omentum. CLINICAL FINDINGS Many gastric and duodenal metastases are…

Carcinoma of the Stomach and Duodenum

Gastric Carcinoma EPIDEMIOLOGY Gastric carcinoma has striking geographic variations, with the highest reported incidence in Japan. However, Japanese who migrate to the United States have a significantly lower incidence of gastric cancer than those living in Japan, so other factors such as diet and Helicobacter pylori infection are thought to play a major role in the development of this tumor. Other predisposing conditions include atrophic gastritis,…

Benign Tumors of the Stomach and Duodenum

Between 85% and 90% of neoplasms in the stomach and duodenum are benign. About 50% are mucosal lesions and 50% are submucosal. Most benign neoplasms are discovered fortuitously on barium studies or endoscopy, but large or ulcerated tumors may cause abdominal pain or upper gastrointestinal (GI) bleeding. Others are important because of the risk of malignant degeneration. Mucosal Lesions Polyps constitute about 50% of benign neoplasms…

Inflammatory Conditions of the Stomach and Duodenum

Erosive Gastritis Erosions are defined histologically as epithelial defects that do not penetrate beyond the muscularis mucosae. Although gastric erosions are rarely diagnosed on single-contrast upper gastrointestinal (GI) studies, they are detected on double-contrast studies in 1% to 20% of patients. PATHOGENESIS Erosive gastritis is most commonly caused by aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs). Other less frequent causes include alcohol, stress, trauma, burns, Crohn’s…

Peptic Ulcers

Gastric or duodenal ulcers (peptic ulcers) are thought to occur in about 10% of adults in the West. Peptic ulcers are important not only because of the frequent occurrence of pain or other symptoms but also because of the morbidity and mortality associated with complications such as bleeding and perforation. Epidemiology and Pathogenesis Duodenal ulcers are more common than gastric ulcers, occurring in adults of all…

Postoperative Esophagus

General Principles Radiologic evaluation of the postoperative esophagus requires an understanding of the operative procedures and normal postoperative findings. Radiographic studies are performed in these patients for three general purposes: (1) to define the postoperative anatomy and establish a baseline; (2) to assess the efficacy of the procedure; and (3) to detect complications during the early (<4 weeks after surgery) or late (>4 weeks after surgery)…

Abnormalities of the Gastroesophageal Junction

Radiographic Technique The gastric cardia is notoriously difficult to evaluate on single-contrast barium studies because the overlying rib cage prevents manual compression of the gastric fundus. If the fundus is not adequately distended, gastric folds may obscure surface detail. If larger volumes of barium are used to distend the fundus, however, it can become so opaque that lesions are obscured. Because of these limitations, double-contrast techniques…

Miscellaneous Abnormalities of the Esophagus

Mallory-Weiss Tear PATHOGENESIS A Mallory-Weiss tear is a linear mucosal laceration at or near the cardia caused by a sudden, rapid increase in intraesophageal pressure due to violent retching or vomiting after an alcoholic binge or protracted vomiting for any reason. , Less commonly, these tears result from prolonged hiccupping, coughing, seizures, straining at stool, or childbirth, or laceration of the esophagus by an endoscope or…

Other Malignant Tumors of the Esophagus

Metastases SITES OF ORIGIN Esophageal metastases are found at autopsy in less than 5% of patients dying of cancer. Carcinoma of the gastric cardia or fundus often invades the distal esophagus, accounting for about 50% of these metastases. Less commonly, lung and breast cancer involve the esophagus by extension of lymphadenopathy or metastatic tumor from the adjacent mediastinum. The esophagus may also be directly invaded by…

Carcinoma of the Esophagus

Esophageal carcinoma comprises less than 10% of all gastrointestinal (GI) tract cancers. Nevertheless, it is a deadly disease, with an overall 5-year survival rate of only about 15%. At one time, most esophageal cancers were thought to be squamous cell carcinomas, but adenocarcinomas arising in Barrett’s esophagus have increased markedly in incidence during the past 50 years. Because of important differences between these tumors, they are…

Benign Tumors of the Esophagus

Benign tumors of the esophagus constitute only about 20% of all esophageal neoplasms. Most are small, asymptomatic lesions, but these tumors may occasionally cause dysphagia or other symptoms, necessitating endoscopic or surgical removal. Depending on their site of origin in the wall, benign esophageal neoplasms may be classified as mucosal or submucosal lesions. Mucosal Lesions SQUAMOUS PAPILLOMA Squamous papillomas are uncommon, accounting for less than 5%…

Other Esophagitides

Drug-Induced Esophagitis Since its original description in 1970, drug-induced esophagitis has been recognized as an increasingly common condition in today’s pill-oriented society. The most frequent causes include tetracycline, doxycycline, potassium chloride, quinidine, nonsteroidal anti-inflammatory drugs (NSAIDs), and alendronate. Because of its ability to detect small ulcers, double-contrast esophagography is a valuable technique for detecting drug-induced esophagitis. PATHOGENESIS The type and degree of injury in drug-induced esophagitis…

Infectious Esophagitis

Because of greater survival of immunocompromised patients, infectious esophagitis has become an increasingly common problem in modern medical practice. Candida albicans is the usual offending organism, but herpes simplex virus and cytomegalovirus (CMV) have also been recognized as opportunistic esophageal invaders. Patients with AIDS may develop fulminant fungal and viral esophagitis, accentuating the need for early diagnosis. Candida Esophagitis PATHOGENESIS Candida albicans is the most common…

Gastroesophageal Reflux Disease

Reflux Esophagitis PATHOGENESIS Gastroesophageal reflux disease (GERD) is the most common inflammatory disease involving the esophagus, with a prevalence of 10% to 20% in the West. , It is a multifactorial process related to the frequency and duration of reflux episodes and the content of the refluxate. Gastroesophageal reflux (GER) occurs when lower esophageal sphincter (LES) pressure is decreased, so the major barrier to reflux is…

Motility Disorders of the Esophagus

Motility disorders of the esophagus are an important cause of esophageal symptoms, especially symptoms not readily explained by structural abnormalities. This chapter reviews esophageal anatomy and physiology before discussing fluoroscopic evaluation of esophageal motility and major esophageal motility disorders. Normal Esophageal Anatomy The esophagus is a 20- to 24-cm long muscular tube composed of outer longitudinal and inner circular muscle fibers. Striated muscle predominates in the…

Barium Studies of the Upper Gastrointestinal Tract

Upper gastrointestinal (GI) tract barium studies can be performed by single- or double-contrast technique. Single-contrast study relies primarily on barium filling and mucosal relief, whereas the double-contrast study is actually a biphasic technique that combines the advantages of single and double contrast. This chapter describes a reasonable approach for performing both types of studies, with emphasis on double-contrast examination because of its superior diagnostic capabilities. ,…