BARIUM STUDIES

Dr. Manik Mahajan

Lecturer Radiology
Date: 30.09.2020
 BARIUM
SWALLOW
BARIUM SWALLOW:

Barium swallow is a
radiological study of
pharynx and esophagus up
to the level of stomach with
the help of contrast.
 ANATOMY OFESOPHAGUS:

Flattened muscular tube, size

18 to 26cm beginning at lower
border of cricoid cartilage (opp
6th cervical vertebra) and
ending at cardiac orifice of
stomach (opp 11th thoracic
vertebra)

Divided into 3 anatomical

segments i.e. cervical, thoracic
& abdominal
 ESOPHAGEAL CONSTRICTION:

• Superiorly: level of Cricoid

cartilage, juncture with
pharynx

• Middle: crossed by aorta and

left main bronchi

•Inferiorly: diaphragmatic
sphincter
 INTRODUCTION :
• It is a medical imaging procedure used to
examine upper gastrointestinal tract, which
include the esophagus and to a lesser extent
the stomach.

• The contrast used is barium sulfate.

 CONTRAST:

• TYPES OF CONTRAST STUDY

• (i) SINGLE CONTRAST STUDY

• (ii) DOUBLE CONTRAST STUDY

• Barium Sulfate is used (barium Carbonate is toxic)

• Barium has atomic no 56 and is radio-opaque

• Barium is inert and non-toxic

 INDICATIONS:
• Dysphagia
• Heart burn, retrosternal pain, regurgitation & odynophagia.
• Hiatus hernia
• Reflux esophagitis
• Stricture formation.
• Esophageal carcinoma.
• Motility disorder like
• Achalasia
• diffuse esophageal spasms.
• Pressure or invasion from extrinsic lesions.
• Assessment of abnormality of
• i. pharyngo esophageal junction including zenkers
diverticulum
• ii. cricoid webs
• iii. cricopharyngeal Achalasia.
 CONTRAINDICATIONS :

• Suspected leakage from esophagus into the mediastinum

or pleura and peritoneal cavities (Diatrazole Meglumine -
66% to be used)

• Tracheo-esophageal fistula (Diatrazole Meglumine -66%

to be used)

• Recent Biopsy
 XRAY VIEWS:

• SOFT TISSUE NECK – AP & LATERAL

• NECK-AP & LATERAL

• THORAX-RAO (right anterior oblique) VIEW

 TECHNIQUE:
• Single Contrast Study:
-Contrast 90-100%W/V
-Approx. 20 ml of contrast given & asked to swallow by
patient.

• Double contrast Study:

-Contrast high density, low viscosity (200-250%W/V)
-15-20 ml given & asked to swallow.
-Then effervescent powder given with another mouthful of
barium.
-In erect posture gas tend to stay up so adequate
distention stays longer time.
-Inj. buscopan I.V given before the procedure to keep
SPECIFIC CONDITIONS
 ESOPHAGEALWEB:

A shelf like projection is

seen in upper part of
cervical esophagus
causing short segment
narrowing, however
contrast is seen passing
distally.
 DIFFUSE OESOPHAGEALSPASM

• Barium swallow shows

irregular areas of narrowing
and dilatation -----
“corkscrew” “rosary bead"
esophagus.

The esophageal muscle is

hypertrophied, but histologically
normal.
ACHALASIACARDIA

• Barium swallow showing

dilatation of the esophageal
body
•
A “bird-peak " like tapering of
the esophagus at the lower
esophageal end.
 HIATUS HERNIA:

• Displacement of the cardio-

esophageal junction above
the esophageal hiatus
•
Part of the stomach is
present in the chest
•
Reflux of barium into the
esophagus
 ESOPHAGEALVARICES:

• Mild dilatation of the esophagus

with multiple persistent filling
defects in the lower third of the
esophagus.
 BARRETT’S ESOPHAGUS:

The reticular mucosa is

characteristic of Barrett's
columnar metaplasia,
especially with the associated
web-like (arrow) stricture.
 ZENKER’S DIVERTICULUM:

A Zenker's diverticulum is a pulsion

hypo pharyngeal false diverticulum
with only mucosa and sub mucosa
protruding through triangular posterior
wall weak site (Killian's dehiscence)
between horizontal and oblique
components of cricopharyngeus
muscle.
The esophagogram shows contrast
filled out pouching from posterior wall
of esophagus at the level of
cricopharyngeus.
 CANDIDA ESOPHAGITIS

Shaggy esophagus associated

with Candida infection , image
"A" depicts the longitudinally
oriented plaque-like lesions
visible in Candida esophagitis ,
image "B" depicts the granular
appearance of the esophageal
mucosa secondary to edema
and inflammation
 CA ESOPHAGUS
• Irregular long segment
narrowing with proximal and
distal end shouldering and
dilatation with hold up of
contrast in proximal
esophagus
• However contrast is showing
passing distally
BARIUM MEAL
 BARIUM MEAL:

• Barium meal is radiological study of lower esophagus,

stomach and duodenum.

• Done by oral administration of contrast media barium

sulphate.
 INDICATIONS:

• 1.Dyspepsia
• 2.Weight loss
• 3.Upper abdominal mass
• 4.Gastrointestinal hemorrhage or unexplained iron
deficiency anemia
• 5. Partial obstruction
 CONTRAINDICATIONS:

• Complete large bowel obstruction

• Suspected Perforation
(Diatriazole Meglumine used)
 CONTRAST:
• 150 ml of high density barium 250 % W/V (Double
contrast) and 80-100% W/V (single contrast)

METHODS :
• 1. Double contrast: Method of choice to demonstrate
mucosal pattern.

• 2. Single Contrast:

• a) Children -since it usually is not necessary to

demonstrate mucosal pattern

• b) Very ill adults – to demonstrate gross pathology only

 PROCEDURE
Patient swallows effervescent agent (only in double
contrast)

• High density barium(250% w/v) is swallowed while

lying on the left side. Then turn to the supine position.
If reflux is observed spot films are taken

 A hypotonic agent –Buscopan(20 mg I.V ) is

administered

 Patient rolled from side to side so barium coats

mucosal surfaces by washing mucus from the gastric
mucosa
SEQUENCES OF FILMS FOR
BARIUM MEAL
EXAMINATION:
SPOT FILMS FOR DUODENALLOOP:
SPECIFIC CONDITIONS
 EROSIVE GASTRITIS

• Central pool of barium

surrounded by a radiolucent
hallow
 GASTRIC ULCER

• Pooling of barium with in

ulcer crater with mildly
thickened rugae
 GASTRIC POLYP

• Multiple well defined filling

defects with a surrounding
ring of barium are noted
along the dependent wall
of stomach suggesting
multiple gastric polyps
 GASTRIC DIVERTICULUM

• An out pouching is noted

from the greater curvature of
stomach showing air contrast
level in it suggestive of
gastric diverticulum
 PYLORIC STENOSIS

• Grossly dilated stomach with

a streak of contrast passing
through narrow elongated
pylorus suggestive of pyloric
stenosis
 BENIGN TUMOR
• A well defined lesion seen
projecting from fundus of
stomach making obtuse
angle with the wall and
surrounding normal mucosa
suggestive of benign GIST.
 GASTRIC CARCINOMA
• Marked mucosal
irregularity is noted
involving lower end of
lesser curvature and
gastric antrum causing
marked luminal
narrowing with only
streak of contrast
passing distally
suggestive of neoplastic
etiology.
BARIUM FOLLOWTHROUGH
• Barium Follow Through is designed to
demonstrate the small bowel from the
duodenum to the ileoceacal region
encompassing the duodenum , jejunum and
ileum including the junctions superiorly
with the stomach and inferiorly with the
ascending colon.

• Also known as barium meal follow through

(BMFT) & small bowel follow through (SBFT).
 INDICATIONS:
• Pain
• Diarrhea
• Anemia
• Gastrointestinal bleeding
• Malabsorption
• Crohn’s Disease

• CONTRAINDICATIONS :
• Complete obstruction
• Suspected perforation
 METHODS :
• Single Contrast
• Double Contrast (with addition of an effervescent agent)

• Note: Double contrast technique is normally adopted

CONTRAST MEDIUM:
• Single Contrast 300-400 ml of 50-60% w/v Barium
suspension
• Double Contrast 300-400 ml of 80-100% w/v Barium
suspension
 PROCEDURE :

• Barium sulphate solution 80-100% w/v 300 ml (150

ml if performed immediately after barium meal)

• Usually given in 10-15 min increments or full at once

• In situations where barium is contraindicated, non-ionic

water soluble solutions are used.
FILMING:
• Prone PA films of the abdomen are taken.
• The first radiograph is taken 10 min following the drink,
with the second image at 30 min stage. Then the
radiographs are taken at 30 min intervals until the barium
has reached terminal ileum.
• Pressure on the abdomen helps to compress abdominal
contents so that the loops of small bowel are separated.
Thus for better radiographic quality, prone position is
used.
• Spot films of the terminal ileum are taken supine.
15 min post
contrast
film
30 min post
contrast
1 hour post
contrast
film
Barium Meal + Follow-Through:
 ADVANTAGES:
• Easily performed.
• No discomfort/intubation to the patient.
• It is a physiological process. Hence transit time can be
assessed.

DISADVANTAGES :
• Overlapping of Barium filled bowel loops in the pelvis.
• Poor distension of bowel loops
 Ileo-
vesical
Fistula

A linear fistulous
tract showing
communication
between ilial loop
and bladder
Meckel’s
diverticulum

A large out pouching

from antimesenteric
border of ilium
 Crohn's
Disease

• String Sign
• Cobble
stone
appearance
 Crohn’s
Disease:

• Mucosal
Granularity
• Stricture
Small Bowel
Polyps:

A large filling
defect with in
the bowel wall
Small Bowel
Tumors:

Irregular short segment

narrowing with mucosal
irregularity
BARIUM ENEMA
 BARIUM ENEMA:

• A barium enema is a test used to help visualize the colon

(large bowel).

• A barium enema is used to look for problems in the colon,

such as polyps, inflammation (colitis), narrowing of the
colon, tumors, diverticulitis.
 Indications:

• benign tumors (such as polyps).

• Colorectal carcinoma
• ulcerative colitis (inflammatory bowel disease).
• Hirsch sprung disease in children.
 Contraindications:

• Toxic Mega colon

• Pseudomembranous colitis
• Recent biopsy
• Recent barium meal
 CONTRAST:
• 500 ml barium suspension used

• 1. SINGLE CONTRAST STUDY (20% W/V)

The colon is filled with barium, which outlines the intestine and
reveals large abnormalities.

• 2. DOUBLE CONTRAST (100% W/V)

• the colon is first filled with barium

• then the barium is drained out, leaving only a thin layer of
barium on the wall of the colon.
• The colon is then filled with air. This provides a detailed view of
the inner surface of the colon, making it easier to see narrowed
areas (strictures), diverticula, or inflammation.
Large Bowel Polyps:
 Ulcerative Colitis:

• Lead pipe colon : tubular

ahaustral featureless colon
 Colorectal CA:

• Apple Core
Lesion
 Hirschsprung’sDisease:

• Abrupt transition zone at

recto sigmoid junction;
inversion of recto
sigmoid index
 Diverticular Diseases:

• Multiple small rounded out

pouching from the bowel wall