Normal X-ray anatomy of the esophagus
Last reviewed: 23.04.2024
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On an empty stomach, the esophagus is a narrow tube with collapsed walls. It is not visible on ordinary radiographs. At the time of the act of swallowing, one can observe the movement of air bubbles through the esophagus, swallowed with food, but the walls of the esophagus still do not give an image, so the basis of the radiation study is artificial contrasting with the aid of an aqueous suspension of barium sulphate. The observation of the first small portion of the liquid aqueous suspension allows us to estimate the act of swallowing, the progress of the contrast mass through the esophagus, the function of the esophageal-gastric transition, and the entry of barium into the stomach. The patient's intake of a dense aqueous suspension of barium sulfate makes it possible to slowly examine all segments of the esophagus in various projections and in different positions of the body and, in addition to fluoroscopy, perform all necessary photographs or a video recording.
The esophagus filled with a contrasting mass causes on the roentgenograms an intense ribbon-like shadow with a diameter in different sections from 1 to 3 cm. The shadow begins at the level of CVI, where the flat contour caused by the cricoid-pharyngeal muscle is noticeably on its posterior contour. This is the first physiological constriction of the esophagus (the first esophageal sphincter). At the level of the aortic arch, a flat depression on the left contour of the shade of the esophagus is determined (the second physiological constriction) and somewhat lower - a shallow depression from the left main bronchus (third physiological constriction). Above the diaphragm, the esophagus forms on the inspiration, especially in the horizontal position, a pear-shaped enlargement - the esophageal ampulla.
On inspiration, the progress of the contrast mass stops at the level of the esophageal opening of the diaphragm; the shadow of the esophagus is interrupted in this place. The length of the inside diaphragm segment of the esophagus is 1-1.5 cm. Above, intra- and sub-diaphragm segments form the so-called esophageal-gastric transition, or the vestibule. They are considered as the lower esophageal sphincter (fourth physiological constriction). The right contour of the subdiaphragm segment directly continues with a small curvature of the stomach, and the left contour forms a cardiac notch (angle of the Hyis) with the outline of the arch of the stomach. In healthy people, the angle of the Hyis is always less than 90 °.
The contours of the shadow of the esophagus are always smooth. Peristaltic contractions cause the waves moving along the contours (with a speed of 2-4 cm in 1 s). After the bulk of the contrast mass has passed into the stomach, barium sulphate is retained in the interlining spaces of the esophagus. Thanks to this, the folds (in the norm 3-4) of the mucous membrane can be seen on the photographs. They have a longitudinal direction, wavy outlines, are variable at the time of peristaltic waves.
X-ray examination allows you to evaluate all phases of the esophagus: its relaxation when entering contrast medium, subsequent contractions and, finally, the phase of complete decay (motor pause). Simultaneously, the function of the upper and lower esophageal sphincters is determined. Motor mechanics can also be investigated using dynamic scintigraphy. For this, the patient is offered to swallow 10 ml of water containing a 99 mTc-labeled colloid with an activity of 20 MBq. The movement of the radioactive bolus is recorded on a gamma camera. Normally, the colloid passes through the esophagus in less than 15 seconds.
Foreign bodies of pharynx and esophagus
Every patient who swallows a foreign body must be under medical supervision until it is removed or exited through natural paths. Metallic foreign bodies and large bones are found in fluoroscopy, radiographs and computer tomograms. It is not difficult to establish their nature and localization. Pointed objects (a needle, a nail, pieces of bone) can get stuck in the lower parts of the pharynx and the pear-shaped sinus. If they are low contrast, then an indirect symptom is deformation of the pharyngeal lumen due to soft tissue edema. An increase in the volume of the pre-invertebrate cell is observed when the wall of the neck part of the esophagus is perforated by the foreign body. Sonography and AT facilitate the detection of this lesion (the shadow of a foreign body, small air bubbles in soft tissues, the accumulation of fluid in them).
In the event that, when radiography, a foreign body in the pharynx and esophagus region is not found, images of the abdominal cavity are produced, since the foreign body could pass into the stomach or small intestine. If it is assumed that the foreign body that is not visible on the radiographs is still in the esophagus, the patient is suggested to drink a full teaspoon of a thick suspension of barium sulfate, and then two or three sips of water. Normally, water flushes the contrast mass, but in the presence of a foreign body, it partially lingers on it. Particularly carefully examine the sites of physiological constrictions, since it is in them that most foreign bodies get stuck.
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