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Gastrointestinal Imaging

E2850. Going Down the Right Pipe: Imaging of the Esophagus

Eng K,  Weisiger J,  Spektor M,  Mathur M. Yale New Haven Hospital, New Haven, CT

Address correspondence to K. Eng (

Background Information: With the rapid advances in technology today, many radiologists may feel that barium esophagrams have fallen out of favor in lieu of more advanced forms of imaging. A possible deterrent is the experience and skill level required to perform an esophagram. However, barium esophagrams remain a unique and essential form of diagnostic testing, particularly in patients with symptoms of dysphagia and reflux. Its value is often underestimated; however, the diagnostic information elicited from an esophagram is often unattainable with other forms of imaging. This exhibit will review the technique of performing an esophagram as well as different pathologies including reflux esophagitis and other inflammatory conditions, trauma, infection, and benign and malignant tumors.

Educational Goals/Teaching Points: By the end of this presentation, the learner will be familiar with the technique of a barium esophagram and the purpose of the different phases of the study as well as what type of conditions are best seen on each phase. In addition, the learner will recognize the imaging appearance of various conditions, ranging from inflammatory processes, to benign and malignant etiologic changes, and other miscellaneous conditions.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: The technique includes an upright double-contrast phase with an effervescent agent and high-density barium to evaluate the luminal contour, and a prone single-contrast phase with low-density barium to evaluate functional abnormalities such as dysmotility. The various imaging findings of different conditions will be reviewed including hiatal hernia (sliding, paraesophageal) diverticula (pulsion, traction, pseudo diverticulosis), esophagitis (infection, chemical, iatrogenic), benign neoplasm (leiomyoma, fibrovascular polyp), malignant neoplasm (adenocarcinoma, squamous cell carcinoma), and miscellaneous others (achalasia, scleroderma, trauma, esophagobronchial fistula, Barrett esophagus).

Conclusion: Although barium esophagrams can be difficult to perform and have become less favorable with advanced imaging, they remain important diagnostic tools as they can provide crucial information about the mucosal detail and internal pathology that cannot be obtained by other means of imaging. Both upright and prone phases with dual densities of barium are essential to evaluate both the mucosa as well as the function of the esophagus. It is important to recognize the different pathologies seen on esophagrams as this examination can often serve as a screening tool and necessitate other interventions such as direct visualization with endoscopy.