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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. ,…

Abnormalities of the Pharynx

Functional Abnormalities AGING Age-related change in the muscles, tendons, ligaments, cartilages, and nerves that participate in pharyngeal function may alter swallowing dynamics, causing a swallowing disorder. The type of normal swallowing in young patients is found in only about 15% of people over age 80 years. , For example, loss of sensors at the palatoglossal isthmus and base of the tongue with aging results in poor…

Pharynx: Normal Anatomy and Function and Examination Techniques

The pharynx is the crossroads of respiration, speech, and swallowing. During respiration, the pharynx is an active conduit for the passage of air from the nasopharynx to the laryngeal aditus. During speech, the pharynx functions as a resonating chamber, changing size and shape to alter sounds. During swallowing, the pharynx directs the bolus into the esophagus and prevents the bolus from entering the tracheobronchial tree. Disorders…

Abdominal Calcifications

Physiology Precipitation of calcareous substances requires an alkaline medium and high local concentrations of ionic calcium. The term metastatic calcification refers to deposition of calcium salts in normal tissues secondary to hypercalcemia and an elevated pH. Although the stomach and kidneys are the most frequent sites of metastatic calcification, the degree of opacification in these organs is usually too faint to be detected on abdominal radiographs.…

Abnormal Bowel Gas Patterns and Extraluminal Gas in Abdomen

Even with the widespread availability of cross-sectional imaging studies, abdominal radiography remains a common imaging test in modern radiology practice. Although computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound provide more information about acute abdominal conditions, abdominal radiographs (previously known as abdominal plain films before the advent of digital radiography) have the advantages of relatively low cost and ease of acquisition and can be readily…

Abdomen: Normal Anatomy and Examination Techniques

From the 1970s to 1990s, the abdominal radiograph traditionally served as the initial radiologic means of evaluating patients with suspected abdominal pathology. Since the early 2000s, however, computed tomography (CT) has become the major imaging procedure in patients with acute abdominal signs and symptoms. As a screening test, abdominal radiographs have a low diagnostic yield, especially in patients with mild or nonspecific symptoms. Nevertheless, abdominal radiographs…

The Foot

Foot Checklists 1 Radiographic examination AP Oblique Lateral Axial view of calcaneus 2 Common sites of injury in adults Metatarsals Neck, base, shaft Fifth MT – tuberosity, Jones’ fracture Phalanges Metatarsal/tarsal fracture-dislocation (Lisfranc) Calcaneus – compression fracture Talus Neck Lateral process (snowboarder’s fracture) Subtalar fracture-dislocation Chopart’s fracture-dislocation Navicular Body Proximal pole Tarsal avulsion Lateral view Head of talus Anterior cortex navicular Posterior tuberosity of talus Dorsal…

The Ankle

Ankle Checklists 1 Radiographic examination AP view Lateral view Internal oblique view 2 Common sites of injury in adults Lateral malleolus fibula Medial malleolus tibia Posterior malleolus tibia Pilon fracture of the tibial plafond Fractures of tarsus and midfoot mimicking ankle fractures Tarsal avulsion Lateral view Head of talus Anterior cortex navicular Posterior tuberosity of talus Dorsal surface of calcaneal tuberosity Anterior process of calcaneus Tuberosity…

The Knee

Knee Checklists 1 Radiographic examination AP Obliques (internal and external) Cross-table lateral Sunrise view of patella 2 Hemarthrosis/lipohemarthrosis – distention of suprapatellar bursa Important clue to Underlying obscure fractures Cruciate and collateral ligament and meniscal injuries Most commonly ACL tear 3 Common sites of injury in adults Patella Tibial plateau Distal femur Metaphysis/intercondylar Proximal fibula Head Neck Flake/avulsions Osteochondral fractures Joint surface patella or femoral condyles…

The Hip

Hip Checklists 1 Radiographic examination Hip AP pelvis AP hip Frog leg-view hip Groin lateral hip Femur AP hip AP femoral shaft and condyles Lateral femoral shaft and condyles Oblique femoral shaft 2 Common sites of injury in adults Elderly – low-impact trauma (fall from standing height) Femoral neck Intertrochanteric Greater trochanter Pelvic fractures presenting as hip fractures Pubic rami Iliac wing Adult – R/O pathologic…

The Pelvis

Pelvis Checklists 1 Imaging assessment Radiographic examination AP Oblique views Internal oblique (obturator view) External oblique (iliac view) Inlet view Outlet view Computed tomography (CT) Axial Reformatted images Coronal Sagittal 3-D Volume-rendered semitransparent three-dimensional images to simulate radiographic views AP, inlet, outlet, iliac oblique, obturator oblique Lateral view of high quality Not possible to obtain radiographically 2 Anatomic features Pelvic ring Composed of two innominate bones…

The Thoracolumbar Spine

Thoracolumbar Spine Checklists 1 Imaging assessment Radiographic examination AP Lateral views Computed tomography (CT) Axial Reformatted images Coronal Sagittal 3-D 2 Anatomic features, biomechanics, and forces of injury Anatomy Biomechanics Denis three-column concept Forces of injury Flexion Extension Compression Distraction Shearing Rotation 3 Common forms of fracture and fracture-dislocations in adults Fracture Vertebral body Anterior wedged compression Burst Chance (seat-belt) Flexion-distraction Extension Vertebral appendage Transverse process…

The Cervical Spine

Cervical Spine Checklists 1 Radiographic examination Minimum necessary views Lateral cervical spine to include T1 AP cervical spine AP open-mouth odontoid CT examination: minimum necessary Axial, sagittal, and coronal noncontrast images in bone algorithm Extending through at least the level of T1 Axial and sagittal images in soft tissue algorithm 2 Common sites of injury in adults Craniocervical junction (Skull base – C2) Fractures Occipital condyle…

The Hand

Hand Checklists 1 Radiographic examination PA Pronation oblique Lateral 2 Common sites of injury in adults Fractures Phalanges (55% of hand injuries) Distal (50+% of fractures of the phalanx) Ungual tuft, base, shaft, baseball finger avulsion Proximal (15% of fractures of the phalanx) Shaft, base, condyles, volar plate avulsion Middle (10+% of fractures of the phalanx) Shaft, base, condyles, volar plate avulsion Metacarpals (36% of hand…