RADIOLOGICAL DIAGNOSIS OF DISEASES OF ORGANS OF DIGESTIVE SYSTEM

RADIOLOGICAL DIAGNOSIS OF DISEASES OF

ORGANS OF DIGESTIVE SYSTEM

esophagus

Physiological constrictions:

l  area where pharynx turns into the esophagus

l  where the esophagus fits to the tracheal bifurcation

l  at the level of diaphragm

Parts:

l cervical

l thoracic

l abdominal

The mucous membrane of the esophagus forms 2-3 longitudinal folds running parallel to each other.

The contours of the esophagus are clear, wavy due to peristaltic contractions.

Diseases of esophagus:

Diverticula

l They are a protrusion of a limited area of the wall of the esophagus. The image is defined as an additional shadow adjacent to one of the walls and connected with its lumen.

l They can be single and multiple

Localization

More frequent:

In the middle third,

Along the middle wall.

Sizes

From small to huge bag-shaped cavities that cause dysphagia.

ESOPHAGEAL ACHALASIA

associated with a neuromuscular system disorder, which often leads to stressful conditions. The history of the disease is long, unlike cancer, therefore, there are three stages during the pathological process

Radiographic signs:

Constriction is the main symptom at all stages of the disease.

— circular narrowing (stricture).

— Localization of constriction – abdominal part of the esophagus .

— There are folds of mucous membrane in the narrowed esophagus (destroyed in cancer).

— Seamless junction – In the I^st  stage, the esophagus lacks pre-stenotic expansion, there is only a slight delay in the contrast above the site of narrowing, the esophagus is atonic, looks like a “tube”.

— In the  II^nd stage, the esophagus is expanded up to 4 cm.

— In the III^rd stage the esophagus is expanded up to 7-8 cm, often creates an expansion of the shadow of the mediastinum, barium sulfate does not enter the stomach for a long time.

— The enlarged esophagus in II^nd and III^rd stages hangs over the narrowing site, creating a “mouse tail”symptom.

— There is no gastric air bubble in II^nd and III^rd stages.

CANCER OF ESOPHAGUS

Form of growth:

l exophytic

l endophytic

l mixed

Radiographic signs:

- filling defect

- atypical pattern of mucous membrane

- rigidity of walls

Filling defect

It is determined by tight filling of the esophagus with a contrasting mass, it is presented in the form of lucency at the tumor location.

It can be marginal (along the edge of the shadow of the esophagus) and central (in the center of the organ).

In  exophytic growth, the filling defect has uneven, indistinct contours, localized on one wall of the esophagus or along the entire circumference, the lumen of the esophagus is narrowed at this level, the esophagus expands above the narrowed area (suprastenotic expansion).

In endophytic growth of the tumor, the filling defect is flat, not clearly confined from the uninfiltrated walls, has wavy and clear contours. The constriction may be asymmetric or circular; suprastenotic expansion is more visible.

Atypical pattern

It appears randomly (atypically) with irregularly shaped shadows in the form of spots, stripes, dots instead of the normal (typical) pattern of the mucosa. The folds of the mucous membrane at the border atypical wall pattern break off.

Rigidity of walls

It is caused by their infiltration with cancerous tissue. The thickened wall loses its elasticity and is not able to stretch.

An x-ray symptom of rigidity is expressed by the following: the diameter of the esophagus does not change depending on the degree of contrasting mass filling. There is no peristalsis.

Stomach

X-ray examination of the stomach is performed on an empty stomach; while it is in a collapsd state; As a rule, a gastric air bubbleis clearly visible.

Parts of stomach

l fornix of ventricle

l cardial

l subcardial

l body

l sinus

l antral

l pyloric stomach region

From the stomach, the contrast agent enters the duodenum, in which the upper, descending and horizontal parts are distinguished. In the upper part, an ampoule is isolated - the duodenal bulb.

 

Gastric and duodenal ulcer

Pathomorphologically, an ulcer is characterized by destruction of the wall of the hollow organ of the gastrointestinal tract.

Radiographic signs

l morphological (direct)

l functional (indirect)

l accompanying

Morphological signs

l Niche

l convergence of folds

l cicatricial deformity of the organ

 

Niche is the main radiological symptom, which is visualized differently depending on localization.

If the niche is on the boundary – the edge forming wall:

- additional shadow near the organ contour due to the flow of barium sulfate into the mucous cavity (ulceration);

- the shape of the niche is triangular, the base of the triangle merges with the contour of the organ;

- in case of an acute upper angle of the triangle (niche), there is an acute ulcer если,

- if the rounded top of the niche and its shape is similar to a rounded or oval - chronic ulcer;

- a deep niche extends beyond the contour of the stomach, i.e. its depth exceeds the diameter (in contrast to the malignant niche).

- If the niche is on the mucous membrane, e.g., not on the edge-forming wall, then it looks like a constant contrasting spot (barium sulfate accumulation) of a round, oval or slit-like shape.

Convergence of folds is associated with the development of cicatricial changes in the wall of the stomach, as a result the folds of the mucosa are tightened, converge to a niche.

On the X-Ray image, converging folds are defined as bands of lucency (folds) and linear dimming (grooves) between them, fan-shaped diverging from the ulcer. The folds of the mucosa are usually thickened.

Cicatricial deformity of the stomach and duodenum occurs due to the development of connective tissue in the wall of the affected organ. In the stomach, it leads to deformation of the type of "sand-glass" and "snail", while lesser curvature gets shortened, the pylorus and bulb are pulled upward, and the sinus hangs downward.

Cicatricial deformity of the duodenum can be different, for example, in the form of a trefoil while the bulb cicatrisation.

Functional signs

➢ hypersecretion

➢ local spasm

➢ local hypermotility

➢ change in tonicity and peristalsis 

Local spasm means the formation of retraction on the wall, opposite to the ulcer localization. In case of an ulcer of lesser curvature of the stomach, a regional spasm in the form of a “pointing finger” occurs along the greater curvature.

PENETRATION OF A STOMACH ULCER AND DUODENUM  

Penetration of ulcer — penetration of gastric ulcer or duodenal ulcer into adjacent organs.

It is observed in 10-15% of patients with peptic ulcer disease, more often in men aged 40 years with a long history of peptic ulcer.

Causes of ulcer penetration - associated with the progression of the inflammatory-necrotic process in a chronic ulcer.

A penetrating ulcer is characterized by a niche of large sizes, round in shape, in which there are 3 layers:

• lower — contrast mass

• middle — liquid,

• upper — air.

X-ray images of peptic ulcer or duodenal ulcer:

“KISSING” ULCERS OF BULBS:

Cancer of stomach

Morphological types:

l exophytic

l endophytic (scirrhus)

l mixed

More often cancer develops in antral region (up to 60%), more rare — along lesser curvature (10-15%), rare — along greater curvature and in fornix of ventricle (about 1%).

Diagnosis of gastric cancer is based on general and private radiological signs.

   General:

Radiographic signs:

- filling defect

- atypical pattern of mucous membrane

- rigidity of walls (aperistaltic area)

X-ray examination of colon

It is carried out after taking contrast agent peros, as well as using a contrast enema and administering air into it.

After oral administration of contrast (after 24 hours), the functional state of the colon is studied, defining the time and uniformity of filling of various departments, as well as the nature of the haustration.

A study of the colon with retrograde injection of contrast establishes the nature and extent of organic changes. When intestine is tightly filled, its patency, position, shape, size and contours are determined.

After natural emptying the intestine, one studies the pattern of the mucous membrane, which is visible throughout in the form of transverse folds (in the rectum, the folds are located longitudinally).

Diseases of colon

Intestinal diverticulosis

The frequency of the disease increases with age. If in people under 30 years of age, colon diverticula are found in less than 1% of cases, then at the age of over 40 - already in 10%, older than 60 - 30%, 80 years and older - 60-66%, and approximately the same frequency in men and women.

Causes of diverticulosis:

●      reduction of fiber consumption

●      weakness of the intestinal wall (weakness of the connective tissue framework of the intestinal wall, which develops as the body ages).

●      impaired intestinal motor function.

          Colonic diverticulosis is a morphofunctional pathological process, a characteristic distinguishing feature of which is the presence of sack-like protrusions of the wall of the colon - diverticula.

By localization diverticula in the colon are arranged as follows:  

• in sigmoid colon – 38%

• both in sigmoid and descending colon – 42%

• only in descending colon – 9%

• in transverse colon – 3%

• in caecum and ascending colon – 2%

•           throughout the colon – 6%

Complications of diverticular disease:

➢  bleeding

➢  perforation

➢  infiltrate

➢ abscess formation

➢  enterovesical fistula

Diverticulitis is the most common complication of diverticular disease. Due to hyperemia and edema, the diverticulum with a portion of the adjacent wall increases in size, the serous membrane of the intestine is covered with fibrin, and inflammatory changes can be expressed so that the internal lumen of the affected segment of the colon decreases, the passage of intestinal contents is disturbed.

Colon cancer

Rectum is affected most often, then the blind, sigmoid and transverse parts.

The radiological symptoms of colon cancer are a filling defect, wall rigidity, atypical pattern.

In benign tumors, the filling defect has clear, even contours, its shape is round.