Contrast studies

Gastro-intestinal
 CONTRAST
• Chemical substances which is introduce in the
human body through different roots
• Types of contrast :

• 1) positive contrast: produces radio opaque

shadow eg.: Iodine contrast, barium ..

• 2) negative : produce radio lucent shadow , eg.

air
Routes of contrast
1) Oral
2) anal
3) I.V
4) I.A
5) External orifice in the body surface, eg.
Sinogram, fistulogram, loopogram
GI Contrast studies
• Barium swallow
• Barium meal
• Barium follow though
• Barium enema
GU Contrast studies

• IVU
• Retro grade pyelography
• Cysto graphy
• Urethro graphy
• MCUG
• HSG
Cardio-vascular contrast studies

• Angiography
• Coronary
• Cerebral
• Venography
CT and MRI
I.V contrast administration then obtaining
different phases : -

• Arterial
• Venous
• Delay
Gastro-intestinal Contrast
Agents
1) Barium Sulphate
2) Water-Soluble Iodinated C.M
Barium Sulfate

• The standard opaque contrast agent for routine

fluoroscopic contrast studies of the upper and
lower GI tract
• Cheap, provides excellent coating of the GI
mucosa
• Aspiration of barium rarely causes a clinical
problem. However, huge amounts may result in
pneumonia.
… Barium Sulfate
• The major risk is barium peritonitis resulting
from the spill of barium into the peritoneal
cavity as a result of perforations of the GI tract.

• Barium deposits act as foreign bodies,

inducing fibrin deposition and massive ascites.
Bacterial contamination from intestinal
contents can lead to sepsis, shock, and death
in up to 50% of patients.
Water-Soluble Iodinated Contrast
Media
• Opacify the bowel lumen by passive filling,
rather than mucosal coating
• Considered be inferior to barium agents for
routine fluoroscopic GI studies.
… Water-Soluble C. M

• The major risk of oral water-soluble agents is

aspiration, which causes chemical pneumonitis
(especially with hyperosmolar agents >
pulmonary edema)
• Contraindicated with suspected aspiration/fistula
TO THE LUNG

• Can also cause diarrhea (systemic dehydration)

due to the osmotic activity of the preparation
• Indications:
• when GI tract perforation is suspected (quickly
reabsorbed if perforation is present )
• Meconium ileus (diagnostic and therapeutic)
• Suspected small bowel atresia, used as enema to
delineate micro colon
Gas Agents

• Air and carbon dioxide gas are effective and

inexpensive contrast agents for both CT and
fluoroscopic studies

• used to distend the stomach or colon

Double-contrast techniques
For mucosal coating . Use barium combined
with gas agent for luminal distension (improve
contrast between barium and gas)

Single-contrast techniques
Use only barium/gastrograffin
Barium swallow

• Start from drinking , and finish when contrast

reaches the stomach
• Cine video is preferred to see esophageal
motility

• Used when looking for esophageal stricture,

narrowing, fistula, erosions, displacement,
impingement, reflux, and motility disorders
Barium swallow showing:
Distal esophageal narrowing

Thickening of the stomach

at the fundus

Further evaluation revealed infiltrating

Gastric CA extending to stomach
Persistent proximal
narrowing of the
esophagus at the
level of aortic arch

Differential D include:
• double aortic arch Note the
• Right sided aortic transient
arch narrowing due to
• Apparent right peristalsis
subclavian artery
Other examples
Gastric fundus CA
obliterating
mucosa and
causing distal
esophageal
obstruction
Another example
Another example
Benign gastric
ulcer
(normal mucosa
surrounding it)
Sliding hiatal hernia
(above the diaphragm)
Para esophageal
hiatal hernia

esophagus
Barium meal
• Examines the lower half of the esophagus, the
stomach and all of the duodenum
• Patients fast for 6 h prior to the examination
• Looks for stricture, narrowing, fistula, ulcers,
displacement, impingement, reflux, malrotation,
SMA syndrome
Signs of Hypertrophic pyloric stenosis

Mushroom sign

double track sign

Hypertrophic pyloric stenosis
• causes progressive, projectile, non-bilious
emesis in firstborn males (M:F, 3:1) at 2–12
weeks old
• Now mainly diagnosed by ultrasound
• All thickness ≥4 mm (measuring
from echogenic mucosa to
echogenic serosa) and a channel

length ≥16 mm
Double contrast barium meal
showing
Ulcer at duodenal bulb
(with normal surrounding
mucosa
Barium follow through

• Examines all small bowel till ileo-cecal valve

• Full length abdominal images are taken every
half hour
• Looks for stricture, narrowing, fistula,
impingement, malrotation, filling defects
Barium meal and follow through
showing
narrowing of the third part of
the duodenum
Small bowel enema

• The examination starts from naso-jujenal tube

and ends at ileocecal valve
• more rapid and exact in the detection of small
bowel pathology than a barium follow - through
examination, although more unpleasant for the
patient.
• Looks for stricture, narrowing, fistula,
impingement, malrotation, filling defects
Barium enema

• The examination start from rectum (by means

of a tube placed in the rectum) and ends when
contrast reaches the appendix or ileocecal
valve
• A clean colon is essential and laxatives are
administered the day before the examination.
• Looks for stricture, narrowing, fistula,
impingement, filling defects, ulcers,
diverticulae
… Barium enema

• Contraindications:
● toxic megacolon
● pseudomembranous colitis
● recent radiotherapy;
● recent bowel wall biopsy
Double contrast barium enema -
normal
 Colorectal Carcinoma -
sigmoid
Apple core sign

shouldering
Colorectal Carcinoma –
splenic flexure
Colorectal Carcinoma –
cecum
Colorectal carcinoma with
perforation and leak
Intussusception
• Caused by two telescoping bowel loops
prolapsing into each other.
• The most common location is ileo-colic where
the ileum prolapses into the colon.
• Common and classically presents with colicky
abdominal pain, “currant jelly stool,” and a
palpable right lower quadrant abdominal mass.
…Intussusception
• Most children between 3 months and 3.5 years
old have idiopathic intussusceptions caused by
lymphoid tissue from a preceding viral illness.

• In contrast, both newborns and children older

than 3.5 years often have a pathologic lead
point, which may be an intestinal polyp, Meckel
diverticulum (infants), or lymphoma (children)
• Ultrasound is the primary modality for
diagnosis, which shows a characteristic target
or sign with alternating layers of bowel wall and
mesenteric fat.
• The first line treatment is reduction with an air
or contrast enema.

• Contraindications to pneumatic reduction

include free air, peritoneal signs, and septic
shock.
 Hirschsprung disease

Contrast enema showing a

cone-shaped transition zone at
the junction of the spastic,
narrowed distal colon and the
dilated proximal colon
Hirschsprung disease
• Aganglionosis of the distal bowel, resulting in
lack of relaxivity of the involved bowel.
• caused by arrest of the normal cranio caudal
(proximal-to-distal) migration of vagal neural
crest cells to the distal bowel wall. The anus is
therefore always affected and the involved
bowel is continuous distal to proximal.
• Ranges in severity from isolated internal anal
sphincter involvement (ultra short segment) to
involvement of the entire colon (very rare,
approximately 1–3% of cases, and typically
genetic).
• Definitive diagnosis is with suction biopsy of
the bowel wall.
• Treatment is surgical, resection
THANK YOU