Presentation is loading. Please wait.

Presentation is loading. Please wait.

Gastrointestina l Radiology. Contrast media Type of contrast media –Barium sulfate –Water soluble.

Similar presentations


Presentation on theme: "Gastrointestina l Radiology. Contrast media Type of contrast media –Barium sulfate –Water soluble."— Presentation transcript:

1 Gastrointestina l Radiology

2 Contrast media Type of contrast media –Barium sulfate –Water soluble

3 สารทึบรังสีที่ใช้ตรวจมี 2 ชนิด คือ 1. Barium sulfateBarium sulfate 2. Water-soluble contrast agentWater-soluble contrast agent

4 BARIUM SULFATE

5 WATER SOLUBLE CONTRAST AGENT

6 1. The case in aspiration is suspected, which contrast medium is preferred? 2.The case in perforation is suspected, which contrast media is preferred? Questions

7 TECHNIQUE การตรวจหาความผิดปกติของระบบ ทางเดินอาหารด้วย barium มี 2 วิธี คือ 1. SINGLE CONTRAST STUDYSINGLE CONTRAST STUDY 2. DOUBLE CONTRAST STUDYDOUBLE CONTRAST STUDY

8

9 SINGLE CONTRAST STUDY

10 SINGLE CONTRAST TECHNIQUE

11 DOUBLE CONTRAST STUDY

12 DOUBLE CONTRAST TECHNIQUE

13 PRINCIPLE ความผิดปกติที่พบในภาพถ่ายรังสีของ ทางเดินอาหาร แบ่งได้เป็น 2 ประเภทดังนี้ 1. ความผิดปกติที่เกิดจากพยาธิสภาพนอก ทางเดินอาหาร (Extrinsic lesion)Extrinsic lesion 2. ความผิดปกติของระบบทางเดินอาหาร (Intrinsic lesion) 2.1 Protruded lesion ได้แก่ mucosal fold, polyp, tumor และ varices เป็นต้นProtruded lesionpolyp 2.2 Depressed lesion ได้แก่ ulcer, diverticulum และ perforation เป็นต้นDepressed lesion

14 mucosal mass A submucosal or intramural mass B extrinsic mass C Diagram

15 Extrinsic lesion ความผิดปกติที่เกิดจากพยาธิสภาพนอก ทางเดินอาหาร MASS

16 ความผิดปกติที่เกิดจากพยาธิสภาพนอก ทางเดินอาหาร

17 ความผิดปกติที่เกิดจากพยาธิสภาพของทางเดิน อาหาร : Protruded lesion AB mucosal mass

18 Polyp A B

19 submucosal or intramural mass Diagram

20

21

22 ความผิดปกติที่เกิดจากพยาธิสภาพของ ทางเดินอาหาร : Depressed lesion A B Single contrast Double contrast upright C En-face Profile

23 CARCINOMA

24 CARCINOMA (2)

25 CARCINOMA (3)

26 CARCINOMA (4)

27 CARCINOMA (5)

28 ESOPHGUS

29

30 ACHALASIA CARDIA

31

32

33 THORACIC DIVERTICULUM - Arises in the middle third of the thoracic esophagus - Traction diverticulum (arrow) that develops in response to the pull of fibrous adhesion after mediastinal lymph node infection or inflammation (star)

34 EPIPHRENIC DIVERTICULUM Arises in the distal of the esophagus, just above diaphragm Pulsion diverticulum (arrow) that probably related to incoordination of esophageal peristalsis and relaxation of the lower esophageal sphincter

35

36 1. Serpiginous filling defects which appear as round or oval filling defects resembling the beads of a rosary( dilated venous structures) ( arrowhead). 2. Changes size and appearance with variations in intrathoracic pressure and collapse with esophageal peristalsis and distension. 3. Varices related to portal hypertension are most commonly demonstrated in the lower third of the esophagus. 4. In portal hypertension ; common accompanying gastric varices(arrow). ESOPHAGEAL VARICES : The characteristic radiographic appearance

37 Answer : CANDIDA ESOPHAGITIS INFECTIOUS ESOPHAGITIS : Increasingly common because of the use of steroid and cytotoxic drugs, disseminated malignancy, and increasing incidence of acquired immunodeficiency syndrome CANDIDA ESOPHAGITIS: : Most common infectious disease of the esophagus : Radiographic findings include 1. Abnormql esophageal motility ( dilated, atonic esophagus ) is often an early stage 2. Irregular, nodular, plaque-like mucosal pattern ( arrow), irregular folds(arrowhead) with marginal serrations ( shaggy appearance ) 3. Multiple ulcerations of various sizes 4. Frequently involve the entire thoracic esophagus Esophagogram

38

39 Answer : CORROSIVE ESOPHAGITIS Most severe corrosive injuries are caused by alkalis Barium study is unnecessary during acute phase. Radiographic findings; 1. Diffuse superficial or deep ulceration involving long portion of the distal esophagus 2. Abnormal motility 3. Fibrotic healing results in a long esophageal stricture ( arrow) that extends down to the cardioesophageal junction. Note : barium was aspirated into left main bronchus(green arrow)

40

41 Major radiographic findings: EARLY STAGE - Flat plaque-like lesion or small polypoid lesion) on one wall of the esophagus

42 : Major radiographic appearances (2) : ADVANCED STAGE A. Large Polypoid ( often fungating ) filling defect (arrow) with overhanging edge (yellow arrow) B. Large ulcer niche (yellow arrow) within a bulging mass (ulcerated mass) (arrow)

43 Major radiographic appearances (3) Advanced stage A. Encircling mass with irregular luminal narrowing (green arrow) and shelf like margins (black arrow) B. Nodular thickened folds (varicoid type) (black arrow); Extension of the tumor (green arrow)

44 PSEUDO-ACHALASIA caused by direct spread to the distal esophagus from gastric carcinoma Radiographic findings : 1. Irregularly, narrowed and nodular( arrowhead), sometimes ulcerated (arrow), lesion at distal esophagus 2. Rapid transition between normal and abnormal part. 3. Dilatation of proximal esophagus.

45

46 STOMACH

47

48 WHAT IS YOUR DIAGNOSIS ?

49

50

51 Radiographic appearances of benign gastric ulcer (1) 1. Crater : Barium collection within the ulcer crater Profile view(A): Penetration of the ulcer projecting beyond the normal barium-filled gastric lumen (arrow) En-face view(B): Round or oval barium collection on dependent part (arrow)

52 Radiographic appearances of benign gastric ulcer (2) 2.1 Hampton’s line : an approximately 1-2 mm thin straight line (green arrow)traversing the orifice of the ulcer crater (white arrow) On profile view represent overhanging normal gastric mucosa of undermined ulcer

53 Radiographic appearances of benign gastric ulcer (3) 2.2 Ulcer collar : : smooth thick lucent band (arrow) interposed between the ulcer crater (star) and gastric lumen (G) : represent thickened rim of edematousgastric wall

54 Radiographic appearances of benign gastric ulcer 2.3 Ulcer mound: smooth, sharply delineated, gradually sloping extensive tissue mass (arrow) surrounding the ulcer (arrowhead) : represent severe edematous gastric wall Radiographic appearances of benign gastric ulcer (4)

55 Radiographic appearances of benign gastric ulcer 3. Radiation of smooth thickened folds (arrow) extending directly to the edge of the crater (arrowhead) on profile view(A) and en-face view (B) Radiographic appearances of benign gastric ulcer (5)

56

57 Radiographic appearances of benign gastric ulcer (6) 4. Incisula defect :smooth, deep, narrow, sharp indentation on greater curvature(green arrow) opposite a crater (white arrow) on lesser curvature: spastic contraction of circular muscle

58 Chronic Duodenal Ulcer at duodenal bulb Duodenal Ulcer : More than 95% occur in the duodenal bulb : Associated with H. pylori infection in >95% of cases : Almost always duodenal ulcers are benign : Radiographic appearances 1. Ulcer crater : barium collection on dependent part and air- filled with ring shadow on nondependent part

59 Radiographic appearances: Duodenal Ulcer (1) 2. Thickened folds ( large arrow) 3. Spasm and deformity of the duodenal bulb (small arrow) : barium collection in the ulcer crater (green arrow)

60 Radiographic appearances: Duodenal Ulcer (2) 4. Chronic duodenal ulcer : Deformity of the duodenal bulb from fibrotic healing - Cloverleaf deformity (A) : symmetric narrowing of the midportion of the bulb with dilatation of the inferior and superior recesses at the base of the bulb (arrow) - Pseudodiverticulum (B) : asymmetric narrowing of the bulb

61 Answer : Duodenal Diverticulum - Incidental finding in 5%of barium examination Most common found along the medial border of the descending duodenum at periampullary region Smooth rounded shape with narrow neck projecting beyond the bowel lumen (arrow) stom ach bulb

62 Gastric Diverticulum Least common site of GI diverticula Location : - 75% at posterior wall of fundus (arrow) - Other location :prepyloric area Note : Pseudodiverticulum from chronic duodenal ulcer at duodenal bulb (arrowhead)

63

64 Radiographic appearances : Gastric cancer Polypoid mass - Small polypoid mass in early stage (arrow) may be indistinguishable from benign polyp - Large polypoid carcinoma appear as lobulated or fungating masses - Produce filling defect (arrow) on barium study

65

66 Radiographic appearances : Gastric cancer (1) Focal constricting lesion: localized infiltrating carcinoma or localized scirrhous carcinoma Annular filling defect (arrow)

67 Focal constricting lesion : localized infiltrating carcinoma or localized scirrhous carcinoma - circumferential irregular narrowing of the lumen with rigidity (as figure; involved body and antrum) Radiographic appearances : Gastric cancer (2) body antrumbulb fundus

68 Radiographic appearances : Gastric cancer (3) Linitis plastica pattern - tumor invasion of the gastric wall - diffuse irregular narrowing and rigidity of the stomach

69 Gastric Carcinoma at antrum : malignant gastric ulcer 5% of gastric ulcers are malignant Radiographic appearances: 1. Intraluminal ulcer (not project beyond the expected margin of the stomach ) (arrow) 2. Irregular, nodular mass (arrowhead) surrounding the ulcer 3. Irregular or nodular thickened folds that radiate to the mass 4. Carman meniscus sign : semicircular or meniscoid ulcers (arrow) with its inner margin convex toward the lumen

70 Radiographic appearances : Gastric cancer (4) Ulcerated carcinoma tumor mass (arrowhead) has been replaced by ulceration (arrow)

71

72 Malignant ulcer from gastric leiomyosarcoma Tumor of smooth muscle of GI tract Intramural in origin Radiographic appearances: 1. Intramural or submucosal mass (green arrow) : obtuse angle with the normal bowel wall (white arrow) 2. Variable appearances: intraluminal, exogastric (extrinsic mass) or mixed form 3. Frequently ulceration (black arrow)

73

74

75 COLON

76

77 Radiographic findings : Colonic Diverticulosis 1. Multiple round or oval outpouchings of barium projecting beyond the lumen on profile view (white arrow), barium collection (white arrowhead) or ring-like lesion (black arrowhead) on en-face view

78 Radiographic findings : Colonic Diverticulosis 2. Criss-crossing ridges of thickened circular muscle (sawtooth configuration) (arrow)

79

80 Polyp: focal, protruded lesion within the bowel including neoplastic and non- neoplastic lesion Morphologic Classification : 1. Sessile plaque : flat plaque and base wider than height 2. Sessile hemisphere : semilunar shape polyp and base slightly wider than height 3. Pedunculated sphere : small round polyp with stalk

81

82 Colonic Carcinoma Annular Carcinoma (green arrow) with shelf-like margin (black arrow)

83 Polypoid Carcinoma (arrow) Colonic Carcinoma

84

85 Tuberculous enterocolitis Ileocecal area (80-90%)Ileocecal area (80-90%) Radiographic findings :Radiographic findings : –1. Irregular thickened bowel wall (white arrow) resulting in narrowing of the lumen (coned cecum)(C) –2. Thickened ileocecal valve –3. Wide gap of patulous ileocecal valve (green arrow) –4. Thickened wall of terminal ileum (I) –5. Deep ulcer with/without sinus tract or fistula C I

86


Download ppt "Gastrointestina l Radiology. Contrast media Type of contrast media –Barium sulfate –Water soluble."

Similar presentations


Ads by Google