Movement of the feline esophagus associated with respiration and peristalsis. An evaluation using tantalum markers.

The outer, lateral esophageal walls in the distal half of the esophagus in each of five cats were labeled with small tantalum wires. About 8 wk later, esophageal motion associated with respiration and peristalsis, induced by injecting barium boli (5 ml each) into the proximal esophagus, was recorded on cine and serial biplane roentgenograms while recording intraluminal esophageal pressures simultaneously by manometry. Esophageal motion was also evaluated without a manometric tube in place. The coordinates for each marker were digitized and a computer was used to plot marker position against time. During respiration, the markers passively made a shallow, 2-10 mm excursion on the longitudinal esophageal axis. This movement was synchronous with thoracic and diaphragmatic movement and changes in intraluminal esophageal pressure. Immediately after the onset of peristalsis, the markers made a pronounced oral movement of 10 mm or more above their mean respiratory position, as if to engulf the bolus. Markers in opposing esophageal walls approximated one another and commenced an aboral movement as the bolus tail, which was essentially co-incident with onset of the manometric pressure complex, passed the marker sites. The markers returned to their respective rest positions essentially coincident with passage of the pressure complex peak and then moved below their respective rest positions. The aboral excursion occurred predominantly after the bolus had emptied into the stomach. The magnitude and duration of oral excursion was significantly greater for the distal than for the more proximal markers; conversely, the magnitude and duration of aboral excursion was greater for the proximal than for the more distal markers. During the peristaltic sequence, the labeled portion of the esophagus shortened from 26 to 46% of its resting length. No evidence of esophageal torque was shown. These findings suggest that both the longitudinal and circular esophageal musculature play an active and important role during peristaltic transport of a bolus through the esophagus.

Abdominal computed radiography: evaluation of low-constrast lesions.

Computed radiography has proved useful as a localization device for computed tomography. In an attempt to evaluate computed radiography as a primary diagnostic device, 16 patients were evaluated with various degrees of gallbladder opacification following standard oral cholecystograms, and 15 patients were evaluated with renal masses, identified on standard excretory urography. Subjective evaluation of computed radiographs as compared to the standard radiographs demonstrated no diagnostic advantage to computed radiography. The poor spatial resolution of the computed radiographs was not overcome by the improvement in contrast resolution.

Alimentary tract lesions in Cowden's disease.

Cowden's disease was first recognized by its striking dermatological manifestations and subsequently by the increased incidence of neoplastic involvement of the thyroid and breast. Two cases of Cowden's disease with gastrointestinal polyps are presented to illustrate the alimentary tract involvement in this syndrome, gastrointestinal tract involvement with polyposis being seen in at least 50% of cases. As opposed to the more serious potential of neoplasia in the thyroid and breast, involvement of the alimentary tract has negligible clinical impact to the patient.

Predictability of rectal incontinence on barium enema examination.

The aim of this study was to determine if digital assessment of anal sphincter tone predicts whether a rectal balloon is needed to prevent incontinence during a barium enema examination. During an 8 month , 306 patients scheduled for barium enema examination were evaluated. Immediately before each examination as good, fair, or poor. The barium enema was then performed in a conventional manner. Leakage of even small amounts of barium was scored as rectal incontinence. Ability to retain the barium enema correlated closely with the strength of rectal bone, regardless of patient sex or age. For different sphincter tones the incidence of rectal incontinence was: good, 2%, fair, 30%; and poor, 90%. From these findings it is recommended that, irrespective of patient age and sex, the use of rectal balloon catheters be limited to patients with poor or fair rectal tone.

The value of digital rectal examination before barium enema.

The authors recommend that the radiologist perform a digital examination of the rectum before barium enema. Rectal examination may disclose unsuspected lesions, facilitate tube insertion, indicate inadequate preparation of the colon, and aid in the decision of whether a rectal balloon is to be used.

Rectal balloon catheters and the barium enema examination.

Inflation of a rectal balloon during the barium enema examination has the potential for obscuring rectal lesions or causing rectal injury. The purpose of this communication is to emphasize a rationale for the radiologist that minimizes the use of rectal balloons and reduces the risk of rectal injury when inflation of a rectal balloon is necessary.

Appropriate contrast media for evaluation of esophageal disruption.

The authors discuss the selection of contrast media for radiographic examination of patients with suspected esophageal disruptions, and offer their recommendations.

Gastrointestinal lipomas: a radiologic and pathologic review.

Lipomas of the gastrointestinal tract are an infrequent finding on radiologic examination; however, they occur often enough to warrant consideration in the differential diagnosis of mass lesions of the gut. In many instances, their morphologic characteristics allow the specific diagnosis of a lipoma. In this report, we review gastrointestinal lipomas with an emphasis on their radiologic and pathologic correlation.

Pharynx: value of oblique projections for radiographic examination.

The utility of oblique views for augmenting standard posteroanterior and lateral double-contrast radiography of the pharynx was examined. Over an 8-month period, two oblique views were added to the standard posteroanterior and lateral views of the pharynx during routine upper gastrointestinal studies in 102 patients divided into two groups. Group 1 consisted of 81 patients without suspected pharyngeal or esophageal disease who demonstrated what was considered to be normal anatomy on all radiographic views. Group 2 consisted of 21 patients who were known or suspected to have pathologic abnormality of the pharynx. The members of this latter group each demonstrated various abnormal pharyngeal anatomy on the standard views. In just over half of these cases the oblique projection contributed significant information not obtained with conventional views. Therefore, the authors conclude that oblique images are a beneficial addition to the diagnostic evaluation of patients highly suspected of having pharyngeal disease.

Percutaneous enteral alimentation: gastrostomy versus gastrojejunostomy.

Scintigraphy was used to detect gastroesophageal reflux, determine whether percutaneous gastrostomy (PG) tubes cause reflux, and help in the choice between PG tubes versus percutaneous gastrojejunostomy (PGJ) tubes. During a 2-year period, 46 patients were evaluated with scintigraphy immediately before and 1 week after PG tube placement. Findings in the pre- and postplacement reflux studies were the same in 39 patients (85%). Proof of reflux on either study was considered an indication for conversion to the PGJ tube; at least one study was positive for reflux in 21 patients (46%). All patients were followed up for tube complications, pneumonia, and cause of death. During follow-up, six of 24 patients correctly maintained with PG tubes (25%) and 18 patients with PGJ tubes (39%) developed pneumonia, the cause of death in four of 24 patients with PG tubes (17%) and five of 18 patients with PGJ tubes (28%). The PG tube does not induce reflux, and scintigraphy is useful in selection of patients who can be safely maintained with the PG tube without an increase in the morbidity or mortality associated with reflux and aspiration.

Traumatic diaphragmatic injuries: spectrum of radiographic findings.

Traumatic diaphragmatic injuries are usually caused by blunt trauma or penetrating injuries. The diagnosis may be delayed due to confusing clinical and radiographic findings. According to the results of a review of 25 cases, the diagnosis of diaphragmatic injury is more often delayed and requires more imaging studies in cases of blunt trauma than in cases of penetrating injury. Blunt injury is indicated by asymmetry of a hemidiaphragm or changing diaphragmatic levels, abdominal contents within the chest, diaphragmatic paresis, unexplained hemothorax, or multiple upper abdominal injuries. Penetrating injury is indicated by hemothorax or a missile or blade trajectory through or near the diaphragm. Usually, plain radiography shows initial evidence of traumatic diaphragmatic injury and prompts confirmatory imaging, which includes computed tomography, magnetic resonance imaging, barium studies, fluoroscopy, nuclear medicine, and ultrasound. Nevertheless, the diagnosis of traumatic diaphragmatic injury may be elusive and often can be made only during exploratory surgery.

Desirability of roentgen esophageal examination immediately after pneumatic dilatation for achalasia.

Although infrequent, esophageal rupture is a serious complication of pneumatic dilatation for the treatment of achalasia. Because of an experience with delayed recognition of esophageal perforation in a patient with achalasia, we now examine the esophagus using a water-soluble contrast medium immediately following every pneumatic dilatation. This technique allows immediate detection of esophageal perforation.

A comparison of colonoscopy and roentgenography for detecting polypoid lesions of the colon.

This study compares the effectiveness of the roentgen and colonoscopic examination of the colon for detecting polypoid lesions. We evaluated the findings in 64 patients with suspected or known polypoid lesions who received the same colon cleansing regimen for both examinations, and were studied by examiners of similar expertise. As in other studies, the endoscopist had the advantage of knowing the roentgen findings, and the colonoscopic findings were often taken to indicate whether or not a lesion was present. In about half the patients, however, a second roentgen examination, repeat colonoscopy, or surgical specimen provided additional information for scoring. For example, a filling defect of the same size and location on two roentgen examinations, but not demonstrated at colonoscopy was scored as a false negative colonoscopic finding. The study results indicate that 54% of small polyps less than or equal to 0.9 cm in size were missed on roentgen examination, whereas no proven misses for lesions of this size were shown for colonoscopy. This absence of colonoscopic false-negative findings for small polyps, however, may be partially explained by a relative insensitivity of the roentgen method. For larger lesions greater than or equal to 1.0 cm in size the miss-rate for the two examinations was similar: 15% for roentgen examination and 12% for colonoscopy. We conclude: (1) Colonoscopy is a more sensitive method than roentgen examination for detecting small polyps of the colon, and (2) Performance of the two examinations may be comparable for demonstrating lesions 1.0 cm or larger in size.