Wednesday, 25 March 2015

xrayoftheweek 12: difficulty swallowing

Back to the screening (fluoroscopy) room for the latest #xrayoftheweek case. This is a single image from a barium swallow study in someone who had mild difficulty in swallowing. What can you see?

On this barium swallow study, there are multiple outpouchings from the mid and distal oesophagus. Barium is seen to pool within the outpouchings. Barium is also seen within the stomach indicating there is no complete obstruction, and the images taken during the swallow indicated no stricture. Some tertiary contractions were seen, indicating a degree of dysmotility. There were no similar outpouchings noted involving the upper oesophagus.

This is a case of multiple oesophageal diverticulae. In the mid oesophagus, these are divided into true and false diverticulae: true diverticulae are secondary to traction from outside the oesophagus which creates a pulling force on the wall (for example, in scarring and fibrosis in the mediastinum from old TB); and false diverticulae which are secondary to raised intraluminal pressures and are also named pulsion diverticulae. This particular case was one of multiple false or pulsion oesophageal diverticulae.

There are also types of upper and lower oesophageal diverticula which are outlines in this Radiopaedia article.


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