X-ray of the esophagus

In the oral cavity, with the help of chewing movements of the jaws, teeth and tongue, food is crushed and ground, and under the influence of saliva, it is enzymatically processed, softened and liquefied. The pharynx connects the oral and nasal cavities with the esophagus and larynx. The act of swallowing is a complex process that includes a voluntary - oral and involuntary - pharyngeal-esophageal phases.

During swallowing, the soft palate closes the opening of the nasal cavity, and the epiglottis closes the entrance to the larynx. At the same time, the upper esophageal sphincter, formed mainly by the cricopharyngeal muscle, relaxes. The esophagus is a direct continuation of the pharynx. Its function is to move food into the stomach. The peristaltic wave reaches the lower esophageal sphincter in 5-6 seconds, which relaxes by this point and then immediately contracts, preventing the contents from returning to the esophagus (so-called regurgitation).

The main methods of examining the pharynx and esophagus are X-ray (esophagus X-ray), endoscopy and manometry. Of additional importance are endosonography and radionuclide methods - scintigraphy. The X-ray method makes it possible to evaluate the morphology and function of all parts of the pharynx and esophagus and their relationships with adjacent tissues and organs. Endoscopy is extremely important for the early detection of inflammatory and tumor changes in the mucous membrane and the implementation of a number of therapeutic measures.

Endosonography allows to determine the structure of the esophageal wall, which is important when planning the treatment of esophageal tumor. Manometry is used mainly when a disorder of the esophageal function is established radiologically. Scintigraphy facilitates the detection of disorders of the esophageal function, in particular gastroesophageal reflux.

Normal esophagus on x-ray

When taking an X-ray of the esophagus on an empty stomach, the esophagus is a narrow tube with collapsed walls. It is not visible on regular X-rays. During the act of swallowing, air bubbles swallowed with food can be seen moving along the esophagus, but the walls of the esophagus still do not provide an image, so the basis of the X-ray examination is artificial contrasting with an aqueous suspension of barium sulfate. Even observing the first small portion of liquid aqueous suspension allows for an approximate assessment of the act of swallowing, the movement of the contrast mass along the esophagus, the function of the esophageal-gastric junction, and the entry of barium into the stomach. The patient's intake of a thick aqueous suspension (paste) of barium sulfate makes it possible to leisurely examine all segments of the esophagus in various projections and in different body positions and, in addition to fluoroscopy, to take all the necessary pictures or video recording.

Foreign bodies of the pharynx and esophagus

Each patient who has swallowed a foreign body should be under medical supervision until it is removed or exits through natural passages. Metallic foreign bodies and large bones are detected by fluoroscopy, radiographs and CT scans. It is easy to determine their nature and localization. Sharp objects (needles, nails, pieces of bone) can get stuck in the lower parts of the pharynx and piriform 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 prevertebral tissue is observed when a foreign body perforates the wall of the cervical esophagus. Sonography and AT facilitate the detection of this lesion (foreign body shadow, small air bubbles in soft tissues, fluid accumulation in them).

Normal x-ray anatomy of the esophagus

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X-ray signs of esophageal diseases

Indications for radiographic examination (X-ray) of the esophagus are dysphagia and any unpleasant sensations in the esophagus. The examination is performed on an empty stomach.

Diverticula. A diverticulum is a saccular protrusion of the mucous membrane and submucous layer of the esophageal wall through the slits of the muscular layer. Most diverticula are located in the area of the pharyngeal-esophageal junction, at the level of the aortic arch and the bifurcation of the trachea, in the supradiaphragmatic segment. The pharyngeal-esophageal (border, or Zenker's) diverticulum is formed between the lower fibers of the inferior constrictor of the pharynx and the cricopharyngeal muscle on the posterior wall of the esophagus at the level of CVIII.

Esophageal dyskinesia. Esophageal dyskinesia is manifested in its hypertension or hypotension, hyperkinesia or hypokinesia, in spasms or insufficiency of sphincters. All these disorders are recognized during X-ray examination in the form of acceleration or deceleration of the movement of the contrast mass, the appearance of spastic constrictions, etc. Of the functional disorders, the most common is insufficiency of the lower esophageal sphincter with gastroesophageal reflux, i.e. throwing the contents of the stomach into the esophagus. As a result, inflammatory phenomena develop in the esophagus, superficial and then deep esophagitis occurs. Wrinkling of the esophageal wall contributes to the formation of a hernia of the esophageal opening of the diaphragm.

Hernia of the esophageal orifice of the diaphragm. There are two main types of hernias of the esophageal orifice: axial and paraesophageal.

In an axial hernia, the intra- and subdiaphragmatic segments of the esophagus and part of the stomach are displaced into the chest cavity, the cardiac opening is located above the diaphragm. In a paraesophageal hernia, the subdiaphragmatic segment of the esophagus and the cardiac opening are located in the abdominal cavity, and part of the stomach exits through the esophageal opening of the diaphragm into the chest cavity next to the esophagus.

Esophagitis and esophageal ulcers.

Acute esophagitis is observed after a burn of the esophagus. In the first days, swelling of the mucous membrane of the esophagus and pronounced disturbances of its tone and motility are noted. The folds of the mucous membrane are swollen or not visible at all. Then, uneven contours of the esophagus and the "spotty" nature of its inner surface due to erosions and flat ulcers can be detected. Within 1-2 months, cicatricial stenosis develops, in the area of which there is no peristalsis. The patency of the esophagus depends on the degree of stenosis. If necessary, balloon dilation of the esophagus is performed under fluoroscopy control.

Achalasia of the esophagus. Achalasia - the absence of normal opening of the cardiac orifice - is a relatively frequently observed pathological condition. At the stage of the disease, the radiologist notes a conical narrowing of the subdiaphragmatic segment of the esophagus and a delay in it of the contrast mass for several minutes. Then the cardiac orifice suddenly opens, and the barium quickly enters the stomach. Unlike cancer of the cardiac section, the contours of the subdiaphragmatic segment and the upper part of the stomach are smooth; in these sections, clear longitudinal folds of the mucous membrane are traced. In case of a long-term delay of the contrast mass in the esophagus, a pharmacological test is used. Taking nitroglycerin or intramuscular injection of 0.1 g of acetylcholine promotes opening of the cardiac orifice.

Esophageal tumors. Benign epithelial tumors (papillomas and adenomas) of the esophagus have the appearance of a polyp. They cause a filling defect in the shadow of the contrast agent. The contours of the defect are sharp, sometimes finely wavy, the folds of the mucous membrane are not destroyed, but envelop the tumor. Benign non-epithelial tumors (leiomyomas, fibromas, etc.) grow submucosally, so the folds of the mucous membrane are preserved or flattened. The tumor produces a marginal filling defect with smooth outlines.

Dysphagia

The term "dysphagia" refers to all types of difficulty swallowing. This is a syndrome that can be caused by various pathological processes: neuromuscular disorders, inflammatory and tumor lesions of the esophagus, systemic diseases of connective tissue, cicatricial strictures, etc. The main method of examining patients with dysphagia is radiographic. It allows one to get an idea of the morphology of the pharynx and all parts of the esophagus and to detect compression of the esophagus from the outside. In unclear situations, with negative radiographic results, and also if a biopsy is necessary, esophagoscopy is indicated. In patients with functional disorders established by radiographic examination, esophageal manometry may be necessary (in particular, with achalasia of the esophagus, scleroderma, diffuse esophageal spasm).

X-ray signs of esophageal diseases