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By Angela D. Levy, Koenraad J. Mortele, Benjamin M. Yeh
Gastrointestinal Imaging offers a complete evaluation of gastrointestinal pathologies as a rule encountered through practising radiologists and citizens in education. Chapters are prepared by means of organ method and contain the Pharynx and Esophagus, belly, Small Bowel, Appendix, Colon, Anorectum, Liver, Gallbladder, Bile Ducts, Pancreas, Spleen, Peritoneum, Mesentery, and belly Wall, and a bankruptcy on multisystem issues. a part of the Rotations in Radiology sequence, this booklet deals a guided method of imaging analysis with examples of all imaging modalities complimented by way of the fundamentals of interpretation and approach and the nuances essential to arrive on the top analysis. every one pathology is roofed with a exact dialogue that reports the definition, medical positive factors, anatomy and body structure, imaging suggestions, differential analysis, medical matters, key issues, and additional analyzing. This association is perfect for trainees' use in the course of particular rotations and for examination evaluate, or as a brief refresher for the confirmed gastrointestinal imager.
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Sample text
In secondary achalasia, however, the esophagus is much less dilated because of rapid progression of disease. Moreover, in secondary achalasia, the length of the narrowed segment is often considerably greater than that in primary achalasia because of spread of tumor into the distal esophagus (see Figure 3-3). The narrowed distal esophagus may also be asymmetric, nodular, or ulcerated because of underlying tumor in this region. In patients with secondary achalasia caused by primary carcinoma of the cardia, barium studies may reveal other signs of malignant tumor, with an ulcerated, polypoid, or infiltrating lesion in the cardia and fundus.
Conversely, mucosal nodularity can be obscured by flow artifact when a thick pool of barium prevents visualization of these lesions. Finally, barium precipitates in the esophagus can occasionally be mistaken for tiny ulcers from reflux esophagitis. When any of these artifacts are suspected on double-contrast studies, repeat views should be obtained to demonstrate the transient nature of this finding. Management/Clinical Issues Investigators have shown that double-contrast esophagography can be a useful imaging test for Barrett’s esophagus in patients with reflux symptoms when these individuals are classified as being either at high, moderate, or low risk for Barrett’s esophagus based on specific radiologic criteria.
Other more common findings in Barrett’s esophagus, such as reflux esophagitis and peptic strictures, are often present in patients with uncomplicated reflux disease who do not have Barrett’s esophagus. Thus those radiographic findings that are more specific for Barrett’s esophagus are not sensitive and those that are more sensitive are not specific. Therefore many investigators have traditionally believed that esophagography has limited value in diagnosing Barrett’s esophagus. Differential Diagnosis Reflux Esophagitis ■ Glycogenic acanthosis: This benign degenerative condition may be manifest by mucosal nodularity, but the nodules have discrete borders and are separated by normal intervening mucosa.