The small-caliber esophagus: radiographic sign of idiopathic eosinophilic esophagitis.

Purpose: To evaluate a small-caliber esophagus at barium esophagography with idiopathic eosinophilic esophagitis (IEE) and determine if there is a useful threshold diameter for suggesting this diagnosis.

Materials And Methods: The institutional review board approved this retrospective study and waived informed consent. This study was HIPAA compliant.

Feline esophagus and gastroesophageal reflux.

Objective: The purposes of this study were to reassess the relation between a feline esophagus (transient transverse esophageal folds) and gastroesophageal reflux (GER) and to determine whether a feline esophagus is observed more often during swallowing or during reflux of barium.

Materials And Methods: A computerized search of double-contrast esophagrams was performed to generate four equal groups of 56 patients with marked, moderate, mild, and no GER. The imaging findings were reviewed to determine the frequency of a feline esophagus in these groups and whether this sign was detected during swallowing or reflux of barium.

Pattern approach for diseases of mesenteric small bowel on barium studies.

Despite an array of sophisticated imaging techniques, the barium examination remains a valuable diagnostic test for evaluating structural abnormalities of the small bowel. Most patients can be examined with conventional small-bowel follow-through studies, in which periodic imaging of the entire small bowel is performed by using fluoroscopic guidance; however, some patients may benefit from enteroclysis, in which contrast agents are instilled into the small bowel via a catheter placed in the proximal jejunum for optimal distention and better depiction of individual small-bowel loops. This review for residents discusses the major diseases involving the mesenteric small bowel and presents a pattern approach for the wide spectrum of abnormalities found on barium studies, including polypoid lesions, cavitated lesions, annular lesions, outpouchings, separation of loops, abnormal folds, nodules without abnormal folds, and dilated small bowel.

Chronic diverticulitis: clinical, radiographic, and pathologic findings.

Objective: The purpose of our study is to present a series of 14 patients with chronic diverticulitis on barium enema examinations and to correlate the radiographic findings with the clinical and pathologic findings in these patients.

Conclusion: Chronic diverticulitis is a distinct pathologic entity characterized by the frequent development of chronic obstructive symptoms and abdominal pain rather than the classic clinical findings of acute sigmoid diverticulitis. Barium enema examinations usually reveal a relatively long segment of circumferential narrowing in the sigmoid colon with a spiculated contour and tapered margins, sometimes associated with retrograde obstruction.

Hyperirritable stomach as a cause of nausea and vomiting: clinical and radiographic findings.

Objective: The purpose of our study was to characterize the clinical and radiographic features of the hyperirritable stomach and to determine if it is associated with extraintestinal causes of nausea and vomiting in the absence of gastric outlet obstruction, gastroparesis, or intestinal obstruction or ileus.

Conclusion: The hyperirritable stomach was characterized on barium studies in 15 patients by rapid emesis of ingested barium, a collapsed stomach with little or no retained debris or fluid, and normal emptying of residual barium into nondilated duodenum and proximal jejunum. Fourteen (93%) of these 15 patients had extraintestinal causes of nausea and vomiting, and 13 (93%) of 14 with clinical follow-up had marked improvement or resolution of symptoms after treatment.

Accuracy of retrograde ileostomy radiographic examination for detecting small-bowel abnormalities.

Objective: The purpose of this study was to assess the accuracy of retrograde ileostomy radiographic examination for detecting small-bowel abnormalities in patients with ileostomies.

Materials And Methods: Our database contained the records of 35 patients who had undergone retrograde ileostomy examinations from 1999-2005 and fulfilled our inclusion criteria. The images from the examinations were reviewed to determine the frequency and nature of small-bowel abnormalities, whether lateral views were obtained, and whether the catheter tip was withdrawn to the stoma.

Double-contrast upper gastrointestinal radiography: a pattern approach for diseases of the stomach.

The double-contrast upper gastrointestinal series is a valuable diagnostic test for evaluating structural and functional abnormalities of the stomach. This article will review the normal radiographic anatomy of the stomach. The principles of analyzing double-contrast images will be discussed.

Barium esophagography: a study for all seasons.

Although a variety of diagnostic procedures are often performed on patients with pharyngeal or esophageal symptoms, barium esophagography is a noninvasive, inexpensive, and readily available test that can simultaneously evaluate swallowing function, esophageal motility, gastroesophageal reflux, and a host of structural abnormalities in the pharynx and esophagus. This article reviews the role of barium esophagography for assessing swallowing function, morphologic abnormalities of the pharynx (diverticula, webs, and carcinoma), esophageal motility disorders (achalasia and diffuse esophageal spasm), and morphologic abnormalities of the esophagus (reflux esophagitis, Barrett's esophagus, infectious esophagitis, drug-induced esophagitis, eosinophilic esophagitis, Schatzki's ring, and esophageal carcinoma).

Secondary achalasia and other esophageal motility disorders after laparoscopic Nissen fundoplication for gastroesophageal reflux disease.

Objective: The purpose of our investigation was to determine the frequency of secondary achalasia and other esophageal motility disorders revealed on barium studies after laparoscopic Nissen fundoplication and to present the clinical and radiographic findings in these patients.

Conclusion: Esophageal dysmotility was found in nine (7%) of 138 patients after laparoscopic Nissen fundoplication, including secondary achalasia in three (33%), diffuse esophageal spasm (DES) in two (22%), and a nonspecific esophageal motility disorder in four (44%). Our findings suggest that patients who undergo laparoscopic Nissen fundoplication for gastroesophageal reflux disease are at risk for the development of esophageal motility disorders, including secondary achalasia and DES.

Intraluminal migration of surgical drains after transhiatal esophagogastrectomy: radiographic findings and clinical relevance.

Objective: The objectives of our study were to review our experience with a group of patients in whom contrast examinations after transhiatal esophagogastrectomy and gastric pull-through revealed intraluminal migration of a surgical drain and to describe the radiographic appearance and clinical relevance of this phenomenon.

Conclusion: Our findings indicate that intraluminal migration of a surgical drain after transhiatal esophagogastrectomy is an infrequent but serious phenomenon that hinders or prevents healing of an anastomotic leak. Radiologists should be aware of this phenomenon and should be able to recognize the findings of an intraluminal drain on contrast examinations.

Nonanastomotic strictures after colonic interposition.

Objective: The purpose of this study was to describe the clinical and radiographic findings in a series of patients with nonanastomotic strictures after colonic interposition.

Conclusion: Nonanastomotic strictures usually appear on upper gastrointestinal tract radiography as relatively long segments of smooth, tapered narrowing involving the interposed colon, most likely resulting from chronic ischemia. Unlike strictures at the esophagocolic or cologastric anastomosis, these long nonanastomotic strictures generally have a poor response to endoscopic dilatation procedures and are more likely to necessitate surgical revision of the colonic interposition.

Utility of contrast enema for detecting anastomotic strictures after total proctocolectomy and ileal pouch-anal anastomosis.

Objective: The purpose of our study was to determine the utility of contrast enemas for detecting clinically relevant anastomotic strictures after total proctocolectomy and ileal pouch-anal anastomosis and to facilitate management by defining a critical anastomotic caliber at or below which obstruction is likely to develop after ileostomy closure.

Materials And Methods: Our radiology database revealed 42 patients with contrast enemas after total proctocolectomy and ileal pouch-anal anastomosis who fulfilled our exclusion criteria. The initial postoperative contrast enemas were reviewed blindly to determine the diameter of the ileoanal anastomosis.

Large hiatal hernia with floppy fundus: clinical and radiographic findings.

Objective: The purpose of this study was to compare the clinical and barium radiographic findings for 17 patients with large hiatal hernias and a floppy fundus with those for 61 patients with large hiatal hernias but no floppy fundus.

Conclusions: Patients with large hiatal hernias can develop a floppy fundus, which has a characteristic appearance on barium studies because it droops below the most superior portion of the herniated gastric body. Distortion of the gastric anatomy in patients with this type of hernia can cause mechanical symptoms that usually resolve after surgical repair of the hernia.

Esophageal stents: findings on esophagography in 46 patients.

Objective: The purpose of this report is to assess the findings on esophagography in patients with esophageal stents for palliation of malignant tumors involving the esophagus.

Conclusion: Radiologists should be familiar with findings of little importance (stent narrowing, flow of contrast medium around stent, stent kinks, and apparent esophageal narrowing below stent because of incompletely distended hiatal hernias) versus more important findings (polypoid defects above or below stent, narrowing within or below stent, delayed stent emptying, esophageal-airway fistulas, stent migration, and abutting of distal stent against greater curvature of stomach) on esophagography after stent placement to guide endoscopists regarding the need for stent revision.

Colorectal cancer: screening double-contrast barium enema examination in average-risk adults older than 50 years.

Purpose: To retrospectively determine the diagnostic yield of double-contrast barium enema examinations performed for colorectal cancer screening of neoplasms 1 cm or larger or advanced neoplastic lesions of any size in average-risk adults older than 50 years.

Materials And Methods: The Institutional Review Board at the affiliated Veterans Affairs Medical Center approved this HIPAA-compliant study protocol and did not require informed consent from patients. Computerized databases revealed 276 double-contrast barium enema examinations performed for colorectal cancer screening in average-risk adults older than 50 years.

Anterior abdominal wall hernias: findings in barium studies.

Findings of anterior abdominal wall hernias at computed tomography and magnetic resonance imaging are well documented; however, little information is available about the depiction and characterization of such hernias in barium studies, primarily in small-bowel follow-through examinations. Such examinations are performed frequently, and radiologists should be familiar with the hernia features that may be observed. Anterior abdominal wall hernias are best recognized in profile on lateral spot images from a small-bowel follow-through study when one or more loops of bowel extend beyond the fascial planes of the anterior abdominal wall, with luminal narrowing at the entry or exit site of the hernia or at both sites.

Detection of strictures on upper gastrointestinal tract radiographic examinations after laparoscopic Roux-en-Y gastric bypass surgery: importance of projection.

Objective: Our objective was to determine the optimal radiographic projections for the detection of strictures at the gastrojejunal anastomosis after gastric bypass surgery.

Conclusion: Steep oblique or lateral spot images routinely should be obtained during upper gastrointestinal radiographic studies after gastric bypass surgery to optimize detection of strictures at the gastrojejunal anastomosis.

Association between esophageal dysmotility and gastroesophaeal reflux on barium studies.

Objective: To determine whether there is an association between abnormal primary peristalsis in the esophagus and gastroesophageal reflux (GER) on barium studies.

Methods: A computerized search of radiologic reports revealed 151 patients with esophageal dysmotility (characterized by intermittently decreased or absent peristalsis in the esophagus on upper gastrointestinal tract examinations) who fulfilled our study's entry criteria. These 151 patients were stratified into two groups depending on whether this dysmotility was associated with nonperistaltic contractions (NPCs): 92 patients had no NPCs (Dysmotility and No NPCs Group) and 59 had NPCs (Dysmotility and NPCs Group).

Idiopathic eosinophilic esophagitis in adults: the ringed esophagus.

Purpose: To retrospectively assess the findings of idiopathic eosinophilic esophagitis (IEE) at barium studies and determine the frequency of the ringed esophagus in patients with this condition.

Materials And Methods: The institutional review board approved all aspects of this retrospective study and did not require informed consent from patients whose records were included in the study. The study was compliant with the Health Insurance Portability and Accountability Act.

Crohn's disease in the ileal pouch after total colectomy for ulcerative colitis: findings on pouch enemas in six patients.

Objective: The purpose of this study was to describe our experience with six patients who developed Crohn's disease in the ileal pouch or distal ileum after a total proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis.

Conclusion: Pouch enemas showed characteristic findings of Crohn's disease, including nodularity, thickened folds, ulceration, cobblestoning, strictures, sinus tracks, and fistulas to the perianal region and vagina. It is important for radiologists to be aware of the findings of Crohn's disease in the ileal pouch and distal ileum on radiographic studies of the pouch after total proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis because of the implications for patient management.

Achalasia with complete relaxation of lower esophageal sphincter: radiographic-manometric correlation.

Purpose: To evaluate retrospectively the presence of complete relaxation of the lower esophageal sphincter (LES) at manometry in patients with achalasia depicted on barium esophagograms.

Materials And Methods: The institutional review board approved this retrospective study and did not require informed consent. A search of radiology and manometry records identified 21 patients (12 men, nine women; mean age, 52.

Pharyngeal retention cysts: radiographic findings in seven patients.

Objective: The purpose of this study was to better characterize the radiographic features of pharyngeal retention cysts on double-contrast pharyngograms.

Conclusion: Pharyngeal retention cysts typically involve the valleculae, appearing on double-contrast pharyngograms as small, round or ovoid, well-circumscribed, smooth-surfaced submucosal masses that are best visualized on frontal views of the pharynx. Such features should be highly suggestive of benign retention cysts, obviating further diagnostic workup in asymptomatic patients.

Relationship between diffuse esophageal spasm and lower esophageal sphincter dysfunction on barium studies and manometry in 14 patients.

Objective: We sought to reassess the function and clinical characteristics of the lower esophageal sphincter in a series of patients with radiographically defined diffuse esophageal spasm.

Materials And Methods: In reviewing records in the radiology database at our hospital, we identified 14 patients with diffuse esophageal spasm confirmed on barium studies who also underwent esophageal manometry. The radiographic findings were reviewed and correlated with the manometric findings.

Radiographic examination of the small bowel: survey of practice patterns in the United States.

Purpose: To obtain understanding of the current practice patterns of academic and private radiology groups in the United States in radiographic examination of the small bowel.

Materials And Methods: The survey consisted of questions about small-bowel follow-through (SBFT) examinations, including frequency of overhead radiographs, use of fluoroscopic spot images, personnel performing fluoroscopy, practice settings, and degree of specialization. By using a standard sampling technique, the country was divided into nine regions, and one state from each region was randomly selected.