dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease
TRANSCRIPT
![Page 1: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/1.jpg)
بسم هللا الرحمن الرحيم
![Page 2: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/2.jpg)
Dr. Ahmed Abdallah Eisawy
MBBS M.Sc MD
![Page 3: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/3.jpg)
![Page 4: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/4.jpg)
Enteroclysis
Fast
Mucosa
No overlap
Less Rad.
SBFT
Dilatation
Transit time of Ba
Small bowel
![Page 5: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/5.jpg)
Single Contrast Single Contrast
DC Ba enema
obstruction
Diverticulitis
Ca, Mucosa
Routine: IBD, polyps
Large bowel
![Page 6: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/6.jpg)
Barium studies : Diagnostic findings
1.Sub-mucosal infiltration
2.Dilatation
3.Separation
4.Ulcer
5.Strictures
6.Filling defects
7. Out-pouching
8- Dilution
![Page 7: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/7.jpg)
Cardinal signs of malignancy
Mucosal destruction
Mass
Obstruction
Shouldring
Filling defect
stricture
![Page 8: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/8.jpg)
Sub-mucosal infiltration
• Sub-mucosal infiltration of small bowel (by edema, blood, lymph tissue or neoplasm)
• According to the extent of infiltration 2 patterns exist: stack-of-coins and picket fence
![Page 9: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/9.jpg)
Stack-of-coins
• Stack-of-coins :small amount of infiltration leads to mildly thickened mucosal folds.
• Differential diagnosis includes sprue and scleroderma; they can be further differentiated by dilution of barium due to increases secretion in sprue but not in scleroderma.
![Page 10: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/10.jpg)
Picket fence
• Picket fence :larger amount of infiltration leading to markedly thickened folds.
• It includes Whipple's disease, lymphoma, ischemic or radiation enteritis, tuberculosis & Crohn's disease. Remarkable dilatation of loops in Whipple's disease differentiates this disease from other causes
![Page 11: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/11.jpg)
Ba : Sub-mucosal infiltration
Stack-of-coins Picket fence
![Page 12: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/12.jpg)
Sprue
Stack-of-coins dilatation
Dilution No dilution
Scleroderma
![Page 13: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/13.jpg)
Sprue. celiac disease shows dilatation, contrast-agent dilution, intussusception, barium flocculation, and jejunization of the ileum
![Page 14: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/14.jpg)
+/- Dilated Non-dilated
Whipple’s
Disease Ischemia Hemrrhage Radiation lymphoma
ti
n
g
Picket fence
DD
![Page 15: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/15.jpg)
lymphoma
Polypoid mass
picket fence
![Page 16: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/16.jpg)
Dilatation
• in Whipple' s disease, aneurysmal dilatation in lymphoma .
![Page 17: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/17.jpg)
Lymphoma
Sometimes the excavation appears to
represent a widened area of lumen =
aneurysmal dilatation
Radiographic Features 5 = by Marshak et al
(iv) endoexoenteric with excavation and fistula formation
![Page 18: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/18.jpg)
Separation of bowel loops
• Any process that infiltrates or thickens the bowel wall or mesentery can produce separation of bowel loops.
• Differential diagnosis includes Crohn's disease, lymphoma, carcinoma Carcinoid.
![Page 19: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/19.jpg)
Lymphoma
Sprue pattern
• Segmentation, fragmentation, secretions.
• Separated bowel loops due to
lymphomatous bowel wall infiltration
![Page 20: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/20.jpg)
Lymphoma
Intraluminal filling defects
Intramular
Multiple nodules
![Page 21: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/21.jpg)
Strictures:
• malignant strictures may have an apple core appearance being short with abrupt concentric or irregular luminal narrowing.
• Benign strictures as in ischemic or inflammatory bowel (e.g. Crohn's) tend to be long with less irregularity
![Page 22: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/22.jpg)
Radiation enteritis
Localized folds thick
stricture
Aneurysmal
dilatation
stricture
Separated
loops
lymphoma
![Page 23: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/23.jpg)
Malignant VS Benign stricture A-benign stricture in crohn‘s disease .enteroclysis show a long
benign stricture of a jejunal loop(arrowheads) and a jejunocolic
fistula(arrows)
B-malignant colonic stricture.barium enema shows apple-cole
stricture
Ulcerative colitis
![Page 24: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/24.jpg)
Malignant VS Benign stricture
Benign stricture malignant
Long segment Short segment
Gradual Abrupt
Smooth Mucosal destruction
![Page 25: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/25.jpg)
Crohn disease. Spot view of the terminal ileum from a small-bowel follow-through study demonstrates several narrowing and stricturing, consistent with the string sign. Also note a sinus tract originating from the medial wall of the terminal ileum and the involvement of the medial wall of the cecum.
![Page 26: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/26.jpg)
Double-contrast barium enema studies in a 44-year-old man known to have a long history of ulcerative colitis. Images show total colitis and extensive pseudopolyposis
![Page 27: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/27.jpg)
Synchronous annular carcinomas in the ascending colon and splenic flexure.
![Page 28: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/28.jpg)
• Out pouching of bowel wall
diverticula
![Page 29: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/29.jpg)
Diverticulitis
![Page 30: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/30.jpg)
Diverticular Dse of Colon
![Page 31: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/31.jpg)
Ulcerations
• characteristic fissuring ulcers in Crohn's differentiates it from shallower broader ulcers in ulcerative colitis
![Page 32: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/32.jpg)
Crone disease. Aphthous ulcers. Double-contrast barium enema examination in Crohn colitis demonstrates numerous aphthous ulcers.
![Page 33: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/33.jpg)
Filling defects
• Multiple filling defects in the bowel include a wide differential diagnosis :polyposis, lymphoma, enteritis and Pseudomembranous colitis (PMC)
![Page 35: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/35.jpg)
intestinal obstruction due to ChronicCA descending colon
![Page 36: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/36.jpg)
Dilated bowel
loops proximal to
the obstruction.
Arrow points to the
etiology of
obstruction
![Page 37: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/37.jpg)
Barium enema
Intussusception (Claw sign)
![Page 38: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/38.jpg)
The rectally
administered contrast
material draws around
the head of the
intussusception (arrow)
(Claw sign)
![Page 39: Dr ahmed esawy 2 bowel role of barium study in imaging of bowel disease](https://reader031.vdocuments.us/reader031/viewer/2022030313/58ce8be21a28ab8c3b8b45ed/html5/thumbnails/39.jpg)
LIMITATION OF BRAIUM
1. No direct visualization
bowel wall / extra-mural
2. Ionizing radiation
3. Patient acceptability ??