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Zenkers diverticula
Congenital Pharyngeal
Webs
External Impingement by
osteophytes, enlarged
lymph nodes, tumors or
enlarged thyroids
Traumaswallowed
sharp foreign bodies
(chicken or fish bones),
penetrating trauma,
caustic agents (lye),
iatrogenic injuries.
Inflammation
Pharyngeal Abnormalities
Zenkers diverticula
Congenital Pharyngeal
Webs
External Impingement by
osteophytes, enlarged
lymph nodes, tumors or
enlarged thyroids
Traumaswallowed
sharp foreign bodies
(chicken or fish bones),
penetrating trauma,
caustic agents (lye),
iatrogenic injuries.
Inflammation
Pharyngeal Abnormalities
Benign Tumors
Malignant TumorsSquamous cell carcinoma
most common; may develop at the base of the
tongue, epiglottis, pyriform sinuses, valleculae,
and the palatine tonsils. CT is helpful, not
only in identifying the tumor but also in
detecting invasion of adjacent structures.
Synchronous esophageal carcinoma may coexist
in 5% of patients with head and neck cancer.
Esophageal Evaluation
Indicationsheartburn;
difficult or painful
swallowing; sensation of
food sticking
Methods of examination
at fluoroscopy, the
esophagus is usually
imaged by double
contrast techniques
(barium and
effervescent granules);
water soluble contrast
when perforation
suspected; CT has value
in CA of the esophagus.
Normal
Normal Air-contrast
Air-contrast
Esophagram
Esophagram
Esophageal Diseases
Inflammation
Gastroesophageal Reflux
Disease (GERD)hiatal
hernia; esophagitis;
columnar lined esophagus
(Barretts esophagus)--
occurs in 10-20% of patients
with GERD and have inc.
incidence (15%) of
adenocarcinoma.
Esophageal Diseases
Gastroesophageal Reflux
Disease (GERD)hiatal
hernia; esophagitis;
columnar lined esophagus
(Barretts esophagus)--
occurs in 10-20% of patients
with GERD and have inc.
incidence (15%) of
adenocarcinoma.
in sliding type GE
junction is displaced
cephalad
in paraesophageal
type, the stomach is
along side of a normally
positioned esophagus
mixed type is
combination of the above
with GE reflux,
esophagitis, ulcerations
and strictures can occur
Esophageal Diseases
Inflammation cont.
Extrinsic Agents
caustic (acid or alkaline) ingestion may cause strictures
with and inc. incidence of carcinoma after 3 to 4
decades.
Radiation therapy can cause esophagitis
a variety of oral medications (antibiotics, such as
tetracycline or doxycycline, potassium chloride,
quinidine, vitamin C tablets, and oral ferrous sulfate) can
cause mucosal irritation and ulceration usually because
not enough oral fluids are taken with medication.
Esophageal Diseases
Inflammation cont.
Infectious
Esophagitis
immunosuppression
and general
debilitation are
generally the
background for:
herpes simplex
Cytomegalovirus
Candida infection
Esophageal Disease
Motility Disorders
Presbyesophagus
Diffuse Esophageal
Spasm, the
Nutcracker
Esophagus, and the
Hypertonic Lower
Esophageal Sphincter
Esophageal Disease
Motility Disorders
Achalasiaa
hypertonic lower
esophageal
sphincter; fluid-
filled, dilated
esophagus with
birds beak
appearance distally.
Chagas Disease
picture like that of
achalasia
Barium swallow examination: Early stage: The esophagus has
smooth contour and is narrowed conically at the esophago-
cardial junction (arrow), above this the distal part of the
esophagus is dilated. (=> picture)
Late stage: The esophagus is
extremely dilated above the
severely narrowed cardia (arrow),
with a slightly tortuous course
and inhomogenous contrast
material filling pattern because of
the residual food inside.
Esophageal Disease
Motility Disorders
Sclerodermaloss of
muscle function in the
lower two thirds of the
thoracic esophagus seen
after ingestion of
barium during
fluoroscopy
Miscellaneous
rheumatoid arthritis
(RA), systemic lupus
erythematosus SLE and
alcoholism may have
esophageal dysmotility
Esophageal Disease
Motility Disorders
Esophageal
Diverticula
frequently occur in
the middle and
lower third
Traction typemid-
esophagus
Pulsion typedistal
esophagus
Esophageal Disease
Varices
Esophageal Disease
Varices
produced by either liver
disease with portal
hypertension or thrombosis
of the splenic-portal trunk
occur in the distal
esophagus and bulge into the
esophageal lumen on
esophagram causing
multiple small defects due to
the varicies.
CT can also detect
esophageal or gastric varices
endoscopy most sensitive
method
Esophageal Disease
Foreign bodies (FB)
if radiopaque,
detectable with
plain films
need barium for
non-opaque FBs
in adults, oversized
piece of meat is
most common FB.
1.
Esophageal Disease
Neoplasms
Benign
Leiomyomas
duplication cysts
and lipomas
epithelial polyps
are rare
1.
Esophageal Disease
Malignant Neoplasms
Primaryasymptomatic
until large enough to
interfere with food
transport
Squamous-cellmost
common
Adenocarcinoma
develops in the setting of
dysplastic mucosa ass.
with Barretts esophagus
Esophageal Disease
Malignant Neoplasms
Primary
asymptomatic until
large enough to
interfere with food
transport
Squamous-cellmost
common
Adenocarcinoma
develops in the setting
of dysplastic mucosa
ass. with Barretts
esophagus
Esophageal Disease
Malignant Neoplasms
Lymphomas rare
Spindle-cell tumor
(carcinosarcoma or
pseudosarcoma)
Leiomyosarcoma
Esophageal Disease
Malignant Neoplasms
Lymphomas rare
Spindle-cell tumor
(carcinosarcoma or
pseudosarcoma)
Leiomyosarcoma
Esophageal Disease
Malignant Neoplasms
CT useful in staging
preoperatively
90% accuracy in
detecting
mediastinal
metastases; MRI
has similar
accuracy; CT and
MRI also useful in
detecting liver aorta
metastases
Esophageal Disease
Malignant Neoplasms
Metastatic
lung, breast, and
renal CA as well
as melanoma and
Kaposis sarcoma
(in AIDS
patients) can
involve or spread
to esophagus
Esophageal Disease
Malignant Neoplasms
Metastatic
lung, breast, and
renal CA as well
as melanoma and
Kaposis sarcoma
(in AIDS
patients) can
involve or spread
to esophagus
Esophageal Disease
Trauma
may rupture with major
trauma
rupture more often occurs esophagus
secondary to severe
vomiting (Boerhaaves
syndrome); tends to occur
in the left side of the
lower esophagus and may
extend into the left pleural
space; fluoroscopy with a
small amount of water-
soluble contrast will show
extravasation in area of
rupture
stomac
Esophageal Disease
Trauma
instrumentation may cause
perforation particularly after
dilatation for treatment of stricture
or achalasia
leaks can occur post-operatively
following gastroesophageal
anastomoses
Congenital
Duplication and
Anomalies
Diverticula (tics)
Gastric tics occur in
cardia
Duodenal tics are
common in 2nd and 3rd
portions
duplications are rare
Congenital Rests
aberrant pancreatic
tissue can occur in the
gastric antrum and
proximal duodenum;
Gastritis
Fold Enlargement
and Mucosal
Distortion
Erosionsgastric or
duodenal
The Stomach and
Duodenum Disease-
Peptic Ulcer Disease
Ulcers
most common in the
antrum, pyloric canal,
and duodenal bulb
greater curvature
ulcers are often
caused by ingestion
of medications such
nonsteroidal anti-
inflammatory drugs
Hypergastrinism (Zollinger-Ellison
syndrome)multiple ulcers and inc.
gastric secretion secondary to
gastrinomas; ulcers may be in small bowel
Diseases
Gluten Enteropathy
Miscellaneous Disorders
Menetriers disease
Eosinophilic
gastroenteritis
Scleroderma
Cystic fibrosis may cause
inflammatory changes in
stomach and duodenum
disorders
Nuclear medicine
gastric emptying
studies (radionuclide
is mixed with food).
gastroparesis
especially in diabetics
patients after truncal
vagotomy may combine
lack of motility and
diminished gastric acid
secretion
bezoars may form in
the stomach
Neoplasms
Adenomatous and
Inflammatory Polyps and
Villous Adenomas
Intramural Tumors
(Lipomas, neurofibromas,
and leiomyomas)
Polyposis syndromes
(familial colonic
polyposis, Gardners
syndrome, Peutz-Jeghers
syndrome, Cronkhite-
Canada syndrome)
Adenomatous and
Inflammatory Polyps and
Villous Adenomas
Intramural Tumors
(Lipomas, neurofibromas,
and leiomyomas)
Polyposis syndromes
(familial colonic polyposis,
Gardners syndrome,
Peutz-Jeghers syndrome,
Cronkhite-Canada
syndrome)
CT is useful in
detecting
lymphadenopathy
and liver metastases
but is not accurate in
staging because it
does not accurately
image the true extent
of pathology
Adenocarcinoma
of the stomach
scirrhous
carcinomas (linitis
plastica)
Lymphoma
mimics
adenocarcinoma
stomach
liver
spleen
The Stomach and Duodenum-
Primary Malignant Neoplasms
Carcinoidmay mimic all the
benign and
malignant lesions
The Stomach and
Duodenum-Primary
Malignant
Adenocarcinoma of
Neoplasms
the duodenum is
rare
Small Intestine
Motility Disorders
Scleroderma --dilated SB; ;
mucosal sacculations
Small Intestine
Vascular Diseases
Intestinal Ischemia
mild dilatation or normal on barium
studies
mesenteric artery stenosis on
angiogram
Small Intestine
Foreign Bodies
Spastic colon--functional
Organs of Digestion
Livercongenital
Hemochromatosis
autosomal recessive; defect in iron
absorption causing iron deposition in the
liver, pancreas and skin with classic
triad of cirrhosis, diabetes and bronze
pigmentation
Imaginghyperechoic liver on U.S.;
increased density of liver on non-
contrast images by CT; hypodensity on
T2-weighted images
Organs of Digestion
Liverinflammatory
CirrhosisCT and
UShepatomegaly,
heterogenous
hepatic parenchyma,
nodularity of livers
surface, ascites,
signs of portal
hypertension
including varices
and splenomegaly
Organs of Digestion
Liverinflammatory
Sclerosing cholangitisprogressive
fibrotic inflammation of the biliary
tree leading to biliary obstruction
and cirrhosis. Imaging
cholangiography demonstrates
multiple focal strictures of the bile
ducts
Organs of Digestion
Livertumorous
Cavernous
hemangiomamost
prevalent non-
malignant tumor
Imaginghyperechoic
lesions with posterior
acoustic enhancement
by US; hyperintense on
MRI; enhances from
periphery to center by
CT; increased uptake
on tagged RBCs scan
of liver
Organs of Digestion
Livertumorous
Metastasescolorectal
CA, stomach, pancreas,
breast and lung most
common.
Imagingmost hypodense
on contrast CT; renal and
melanoma may be
hyperintense; MRI equal
to CT in detecting mets
but more expensive and
less effective in detecting
disease elsewhere in the
abdomen.
Needle biopsyCT or US
guidance.
Organs of Digestion
Livertumorous
Hepatocellular CArisk factors are
chronic hepatitis B and C, cirrhosis,
glycogen storage diseases
Imaginghypodense enhancing
lesion that often invades vascular
structures such as the portal vein
Needle biopsy with CT or US
guidance
Organs of Digestion
Liverinfectious
Echinococcal cysts or abscesses-
Imaginghypodense on CT or US
Organs of Digestion
Pancreascongenital
Pancreas divisumlack of fusion of the
dorsal and ventral pancreatic buds
resulting in the main pancreatic drainage
occurring through the minor papilla
(proximal to the papilla of Vater) that may
be too small to accommodate the full
volume of pancreatic secretions, resulting
in obstruction and pancreatitis
ImagingERCP and MRI
Organs of Digestion
Pancreastumorous
CA pancreas95% are
adenocarcinomas with dismal
prognosis; other tumors include
insulinoma, gastrinoma, macrocystic
and microcystic adenomas
Imaging3 or 4 phase CT best
showing hypodense mass;
hypoechoic on US
Splenic vein
Longitudinal
image
g
References
Essential Radiology, Richard Gunderman,
Thieme publishers, 1998.
http://brighamrad.harvard.edu
http://www.indyrad.iupui.edu/rtf/index.html
http://www.rad.uab.edu:591/tf/browse_search
.htm
http://www.uhrad.com/Default.htm
http://
www.learningradiology.com/medstudents/med
s
tudtoc.htm
http://www.vh.org/Providers/Providers.html