Читать книгу The Esophagus - Группа авторов - Страница 166

Barium studies of the esophagus are usually performed as biphasic examinations that include both upright double‐contrast views with a high‐density barium suspension and prone single‐contrast views with a low‐density barium suspension [67]. The patient first ingests an effervescent agent and then rapidly gulps the high‐density barium in the upright, left posterior oblique (LPO) position in order to obtain double‐contrast views of the esophagus. The esophagus normally has a smooth, featureless appearance en face and a thin white etching where it is seen in profile (Figure 6.35A). Occasionally, collapsed or partially collapsed views may show the normal longitudinal folds as thin, straight, delicate structures no more than 1–2 mm in width (Figure 6.35B). The patient is then placed in a recumbent, right‐side down position for double‐contrast views of the gastric cardia and fundus. The cardia can often be recognized by the presence of three or four stellate folds that radiate to a central point at the gastroesophageal junction (GEJ), also known as the cardiac rosette [68] (Figure 6.35C). In some patients with tumor involving the cardia, these lesions may be manifested by distortion, effacement, or obliteration of this rosette.

Figure 6.23 Lymphoid hyperplasia of the tongue base. Barium fills the grooves between smooth ovoid nodules symmetrically distributed on the vertical surface of the tongue.

After the double‐contrast phase of the examination is completed, the patient is placed in the prone, right anterior oblique (RAO) position and takes discrete swallows of a low‐density barium suspension in order to evaluate esophageal motility. Esophageal dysmotility is considered to be present when abnormal peristalsis is detected on two or more of five separate swallows [69]. The patient then rapidly gulps the low‐density barium suspension to optimally distend the esophagus (particularly the distal esophagus) in order to rule out rings or strictures that could be missed on the double‐contrast phase of the examination. Finally, the patient is turned from a supine to a right lateral position to assess for spontaneous gastroesophageal reflux or for reflux induced by a Valsalva maneuver or water‐siphon test.