X-ray of the esophagus

In the oral cavity, the masticatory movements of the jaws, teeth and tongue grind and grind food, and under the influence of saliva - its enzymatic processing, softening and liquefaction. The pharynx connects the oral and nasal cavities with the esophagus and larynx. The swallowing act is a complex process, involving an arbitrary - oral and involuntary - pharyngeal-esophageal phase.

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

The main methods of examining the pharynx and esophagus are the x-ray (X-ray of the esophagus), endoscopy and manometry. Endosonography and radionuclide technique - scintigraphy - are of additional importance. X-ray method makes it possible to assess the morphology and function of all parts of the pharynx and esophagus and their relationship with neighboring tissues and organs. Endoscopy is extremely important for the early detection of inflammatory and tumor changes in the mucosa and the performance of a number of therapeutic measures.

Endosonography makes it possible to determine the structure of the esophageal wall, which is important when planning the treatment of a tumor of the esophagus. Manometry is used primarily when roentgenologic disorders of the esophagus are established. Scintigraphy facilitates the detection of disorders of the esophagus, in particular gastroesophageal reflux.

Normal esophagus on X-ray

With the X-ray of the esophagus 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.

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).

 Normal X-ray anatomy of the esophagus

[1], [2], [3], [4], [5], [6], [7], [8], [9]

X-ray signs of diseases of the esophagus

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

Diverticula. Diverticulum is a saccular bulging of the mucous membrane and the submucosal layer of the esophagus wall through the slits of the muscular layer. Most diverticulums are located in the region of the pharyngeal esophagus, at the level of the aortic arch and in the bifurcation of the trachea, in the supra-diaphragm segment. The pharyngeal-esophageal (borderline, or Center) diverticulum is formed between the lower fibers of the lower pharyngeal constrictor and the cricoid-pharyngeal muscle on the back wall of the esophagus at the level of CVIII.

Dyskinesia of the esophagus. Dyskinesia of the esophagus is manifested in its hypertension or hypotension, hyperkinesia or hypokinesia, in spasms or insufficiency of sphincters. All these disorders are recognized by X-ray examination in the form of acceleration or slowing of the progress of contrast mass, the appearance of spastic constrictions, etc. Of the functional disorders most often observed failure 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, surface, and then deep esophagitis develops. The wrinkling of the esophagus wall promotes the formation of a hernia of the esophageal aperture of the diaphragm.

Hernia of the esophageal opening of the diaphragm. There are two main types of hiatal hernias: axial and para-esophageal.

In the axial hernia, the intra- and sub-diaphragm segments of the esophagus and part of the stomach are displaced into the thoracic cavity, the cardial opening is located above the diaphragm. In the paraeophageal hernia, the sub-diaphragm segment of the esophagus and the cardial opening are located in the abdominal cavity, and part of the stomach leaves the esophageal opening of the diaphragm into the thoracic cavity next to the esophagus.

Esophagitis and ulcers of the esophagus.

Acute esophagitis is observed after a burn of the esophagus. In the early days, edema of the mucous membrane of the esophagus and marked violations of its tone and motor skills are noted. The folds of the mucous membrane are swollen or not visible at all. Then, the unevenness of the esophagus contours and the spotted nature of its internal surface can be detected due to erosion and flat ulceration. Within 1-2 months, cicatricial narrowing develops, in the region of which there is no peristalsis. The passage of the esophagus depends on the degree of stenosis. If necessary, balloon dilatation of the esophagus is performed under fluoroscopy control.

Achalasia of the esophagus. Akhalasia - the absence of a normal opening of the cardial opening - a relatively often observed pathological condition. At the stage of the disease, the radiologist notes the conical narrowing of the sub-diaphragmatic segment of the esophagus and the delay in it of the contrast mass for several minutes. Then the cardial opening suddenly opens, and barium quickly enters the stomach. In contrast to cancer of the cardial department, the contours of the subdiaphragm segment and the upper part of the stomach are even; in these departments, there are clear longitudinal folds of the mucosa. With prolonged delay of contrast mass in the esophagus resort to a pharmacological test. Taking nitroglycerin or intramuscular injection of 0.1 g of acetylcholine promotes the opening of the cardial opening.

Tumors of the esophagus. Benign epithelial tumors (papillomas and adenomas) of the esophagus have the appearance of a polyp. They cause the defect of filling in the shade of the contrast medium. The contours of the defect are sharp, sometimes shallow, the folds of the mucous membrane are not destroyed, but the tumor is circumscribed. Benign non-epithelial tumors (leiomyomas, fibromas, etc.) grow submucous, so the folds of the mucous membrane are preserved or flattened. The tumor gives an edge filling defect with even outlines.

Dysphagia

The term "dysphagia" refers to all the types of difficulty swallowing. This is a syndrome that can be caused by various pathological processes: neuromuscular disorders, inflammatory and neoplastic lesions of the esophagus, systemic connective tissue diseases, scar strict strictures, etc. The main method of examining patients with dysphagia is radiographic. It allows you 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 results of radiography, and also with the need for biopsy, esophagoscopy is indicated. In patients with functional impairment, established by X-ray examination, esophageal manometry may be necessary (in particular, in the case of achalasia of esophagus, scleroderma, diffuse esophageal spasm).

X-ray signs of diseases of the esophagus