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GIT X-ray

Protocols

X-ray gastric outlet obstruction:

x-ray-1



X-ray finding of GOO:

1.Barium meal and follow through may show an enlarged stomach .

2. Dye is not passing beyond the pylorus


Cause: 

  1. Peptic ulcer disease.
  2. Chronic pancreatitis.
  3. Acute pancreatic fluid collections.
  4. Crohn disease.
  5. Caustic ingestion.
  6. Bouveret syndrome.
  7. Large gastric polyps.
  8. Gastric bezoars.

X-ray Hiatus Hernia:



Image

FIG -A findings:

Chest X-ray PA view showing cavity with air–fluid level superimposed on the heart shadow.

There is also a diaphragmatic hump on the right side.

Differential diagnoses:

  • • Lung abscess (involving left lower lobe)
  • • Hiatus hernia
  • • Achalasia cardia

Occasionally in hiatus hernia, there may be air with fluid level behind the heart. To confirm

the finding, barium swallow of oesophagus in Trendelenburg position or endoscopy should be done.

  1. Q: Mention further investigations.
  2. A: As follows:
    • • Chest X-ray lateral view to exclude lung abscess
    • • Barium swallow of oesophagus (in Trendelenburg position to exclude hiatus hernia)
    • • Endoscopy


Image

FIG-D findings:

Chest X-ray PA view showing cavity and air–fluid level in the left lower zone, obscuring the left lower border

of heart and left cardiophrenic angle. Also left dome of diaphragm is raised. The apex of the heart is on the right side.

Diagnosis: Hiatus hernia with dextrocardia.

  1. Q: What is the differential diagnosis?
  2. A: Left-sided eventration with dextrocardia.
  1. Q: What investigations should be done in this case?
  2. A: As follows:
    • • X-ray chest left lateral view
    • • CT scan of chest
    • • USG of whole abdomen


Achalasia of oesophagus:

Image

CXR-1:Achalasia of oesophagus

CXR-1 Barium swallow of oesophagus showing:

  • • Stricture with smooth tapering at the lower end of oesophagus.
  • • Slight dilatation in the middle and upper parts with loss of peristalsis.
  • • There is absence of fundal gas.

Diagnosis: Achalasia of oesophagus (also called achalasia cardia).



  1. Q: What are the differential diagnoses?
  2. A: As follows:
    • • Carcinoma of oesophagus (in such case, there is filling defect, irregular narrowing with shouldering; usually no dilatation).
    • • Benign stricture of oesophagus (due to reflux oesophagitis).

What are the x-ray features of intussusception?











To summarize, the radiographic signs of intussusception are: 1) target sign, 2) crescent sign, 3) absent liver edge sign (also called absence of the subhepatic angle), and 4) a bowel obstruction. Recall that the target sign is a mass in the right upper quadrant.