Radiology of the Pharynx and the Esophagus by Olle Ekberg MD, Göran Nylander MD (auth.), Olle Ekberg MD, PDF

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Example text

When properly performed the radiologic examination should start with a careful penetration of the clinical history. The examination should then be custom-tailored to each patient’s specific complaints. The patient who complains of difficulties with certain foods should be examined with such food. The patient who complains particularly of choking during eating must be carefully examined for misdirected swallowing. The patient who complains of heartburn should be examined with respect to gastro-esophageal reflux disease.

2). The solid bolus used for the radiologic examination must be standardised. We prefer to use a radiolucent antacid tablet with a known diameter of 13 mm (van Westen and Ekberg 1993) This is swallowed together with thin liquid barium (40% w/v). Others have advocated the use of a barium tablet, a bread sphere, or a marshmallow (Curtis et al. 1987; Kelly 1961; Somers et al. 1986). Contraindications for tablet swallowing are known or suspected pharyngeal dysfunction with misdirected swallow. If this is suspected, the patient should first undergo evaluation of the pharyngeal stage and if misdirected swallowing is present with barium reaching below the vocal folds the solid tablet should not be given.

The esophageal examination starts with effervescent tablets and the patient is asked to rapidly drink the high density barium (240% w/v). Double contrast radiograms are taken in left and right oblique projections. Patients with painful swallow should be evaluated for esophagitis such as Candida. The radiologist should always be careful in evaluating for neoplastic lesions such as superficial carcinomas. 34 Evaluation of esophageal function often needs to be done in a recumbent position. However, if esophageal dysfunction is already revealed in an erect position it is usually not warranted to place the patient recumbent as dysfunction in the erect position is not known to become normal in the recumbent position.

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