Gi Barium Cases

Front 1

Back 1

Zenker’s diverticulum

Findings:
Focal contrast collection along the posterior lateral proximal esophagus connecting by a thin neck
Found at the cricopharyngeus, the Killian’s dehiscence
ddx:
NONE!
This is an Aunt Minnie!

Front 2

Back 2

Gastric carcinoma

Findings:
Large mass projecting into the fundus with a large central ulcer
loss of normal folds and wall contour
ddx:
leiomyosarcoma
lymphoma
metastasis

Front 3

Back 3

Long esophageal stricture

Findings:
long segment of esophageal narrowing
loss of normal mucosal pattern
ddx:
lye ingestion
Long-term nasogastric intubation
radiation

Front 4

Back 4

Achalasia

Findings:
tight stenosis of the distal gastroesophageal junction = “bird’s beak” appearance
dilated proximal esophagus
ddx:
pseudoachalasia
Malignant stricture
Benign stricture
Chagas disease

Front 5

Back 5

Pancreatitis

Findings:
diffuse narrowing of the duodenum
splaying of the “C-loop
loss of normal mucosal pattern
ddx:
large tumor
pseudocyst
hemorrhage

Front 6

Back 6

Area gastrica

Findings:
Fine linear polygonal pattern of the gastric body seen on a double contrast study
This is a normal fold pattern
ddx:
NONE!
This is an Aunt Minnie!

Front 7

Back 7

Ascariasis

Findings:
serpentine intraluminal foreign bodies = ascaris worms
thin ribbon of contrast = barium WITHIN worm GI tract
ddx:
NONE!
This is an Aunt Minnie!

Front 8

Back 8

Benign gastric ulcer

Findings:
Single ulcer along lesser curvature
Benign features:
Crater projects beyond lumen
Hampton’s line
Thin, regular radiating folds
ddx:
NONE!
This is an Aunt Minnie!

Front 9

Back 9

Barrett’s esophagus

Findings:
Segmental narrowing of the distal esophagus with smooth tapering margins, ulcerations, and loss of normal mucosal pattern
ddx:
GERD
radiation
malignancy

Front 10

Back 10

Boerhaave’s syndrome

Findings:
focal horizontal contrast extravasation in the posterior distal esophagus
surrounding abnormal posterior mucosa
ddx:
Iatrogenic
Tumor

Front 11

Back 11

Barrett’s esophagus

Findings:
Segmental narrowing of the distal esophagus with smooth tapering margins, ulcerations, and loss of normal mucosal pattern
ddx:
GERD
radiation
malignancy

Front 12

Back 12

Bezoar

Findings:
mass-like gastric luminal filling defect composed of undigested or partially digested food
may cause obstruction
ddx:
NONE!
This is an Aunt Minnie!

Front 13

Back 13

Pseudomembranous colitis

Findings:
numerous thickened folds of the transverse and descending colon
sloughed mucosa or debris within the lumen
ddx:
Ischemic colitis
Ulcerative colitis
Crohn’s disease
Infectious colitis

Front 14

Back 14

Candida esophagitis

Findings:
numerous plaque-like filling defects of the distal esophagus
no erosions or narrowing seen
may appear worse with disease severity
ddx:
NONE!
This is an Aunt Minnie!

Front 15

Back 15

Caroli’s disease

Findings:
percutaneous cholangiogram shows marked dilated and beaded appearance of the intrahepatic biliary system
ddx:
NONE!
This is an Aunt Minnie!

Front 16

Back 16

Cholangiocarcinoma

Findings:
percutaneous cholangiogram shows smooth narrowing of the biliary duct confluence and proximal common hepatic duct
ddx:
NONE!
This is an Aunt Minnie!

Front 17

Back 17

Lye stricture & colonic interposition

Findings:
Long segmental distal esophageal narrowing
Anteriorly located bowel loop connecting mouth of stomach = interposed colonic loop
ddx:
NONE!
This is an Aunt Minnie!

Front 18

Back 18

Apthous ulcers

Findings:
Numerous shallow mucosal defects with a surrounding mound of edema = “bull’s eye” or “target” lesions
do NOT penetrate beyond the muscularis mucosa
ddx:
Crohn’s disease
Infectious colitides

Front 19

Back 19

Inflammatory polyps

Findings:
islands of normal or edematous mucosa seen during active inflammation
they protrude into the lumen because the surrounding mucosa is sloughed or deeply ulcerated
ddx:
ulcerative colitis
Infectious colitis
Crohn’s disease (“cobblestone pattern”)

Front 20

Back 20

Crohn’s disease

Findings:
multiple loops of small bowel show segmental narrowing, loss of normal mucosal pattern (cobblestone), and fistula formation
striking involvement of the terminal ileum
ddx:
lymphoma
Tuberculosis
Yersinia (TI only)

Front 21

Back 21

Duodenal adenocarcinoma

Findings:
eccentric sessile lesion with an irregular, ulcerated surface along the lateral wall of the descending duodenum
ddx:
sessile polyp
leiomyoma / leiomyosarcoma
metastasis

Front 22

Back 22

Heterotopic gastric mucosaof the duodenal bulb

Findings:
numerous, slightly elevated lesions measuring a few millimeters clustered in a small segment of the duodenal bulb
may have angulated or plaque-like margins
occur in up to 20% of pts.
no clinical significance
ddx:
benign lymphoid hyperplasia (if 1-2mm smooth filling defects)

Front 23

Back 23

Erosive gastritis

Findings:
numerous 3-4mm shallow mucosal defects with a surrounding mound of edema = “bull’s eye” or “target”
do NOT penetrate beyond the muscularis mucosa
ddx:
Idiopathic (50%)
NSAIDs (greater curve)
Crohn’s disease (apthous ulcers)
Alcohol ingestion

Front 24

Back 24

Benign gastric ulcer

Findings:
single ulcer along lesser curvature
benign features:
Crater projects beyond lumen
Hampton’s line
Thin regular radiating folds
ddx:
NONE!
This is an Aunt Minnie!

Front 25

Back 25

Colon carcinoma

Findings:
Circumferential narrowing of sigmoid colon with loss of normal mucosal pattern = “apple core lesion”
ddx:
Diverticulitis
Ischemic stricture

Front 26

Back 26

Whipple’s disease

Findings:
Mild thickening of the small bowel folds = ? due to mild lymphangiectasia
Fine micronodular pattern (1-2mm)
Low density LAN on CT
ddx:
Primary Lymphangiectasia
Protein-losing enteropathy
Hypoalbuminemia
MAI

Front 27

Back 27

Heterotopic gastric mucosaof the duodenal bulb

Findings:
numerous, slightly elevated lesions measuring a few millimeters clustered in a small segment of the duodenal bulb
may have angulated or plaque-like margins
occur in up to 20% of pts.
no clinical significance
ddx:
benign lymphoid hyperplasia (if 1-2mm smooth filling defects)

Front 28

Back 28

Villous adenomaof the rectum

Findings:
Sessile filling defect with a papillary surface along the lateral wall of the rectum
ddx:
Villous adenocarcinoma

Front 29

Back 29

Esophageal atresia

Findings:
Abrupt transition of the esophageal barium column
Smooth, rounded inferior margin
Associated with tracheo-esophageal fistula and VATER
ddx:
NONE!
This is an Aunt Minnie!

Front 30

Back 30

Gastric varicies

Findings:
Numerous serpentine thickened folds in the cardia and fundus along the greater curvature
Isolated – think splenic vein thrombosis
ddx:
Gastric adenocarcinoma
Lymphoma
Menetirier’s disease

Front 31

Back 31

Esophageal carcinoma

Findings:
Long segmental severe narrowing of the distal esophagus
Irregular, ulcerated mucosa
ddx:
Lymphoma
Severe GERD stricture

Front 32

Back 32

Ulcerative colitis &inflammatory polyps

Findings:
Ahaustral, granular mucosa of the hepatic flexure
Numerous scattered polypoid filling defects
ddx:
NONE!
This is an Aunt Minnie!

Front 33

Back 33

Esophageal diverticulumfilled with debris

Findings:
Pulsion diverticulum of the anterior esophagus filled with food and debris
Chronic halitosis
ddx:
NONE!
This is an Aunt Minnie!

Front 34

Back 34

Ulcerative colitis &malignant stricture

Findings:
Ahaustral, granular mucosa = UC
Focal stricture of the sigmoid
ddx:
Benign stricture
Ischemic stricture

Front 35

Back 35

Familial adenomatous polyposis

Findings:
Innumerable small round and oval filling defects measuring approximately 2-3mm distributed throughout the colon = “carpet”
High risk of carcinoma
Prophylactic colectomy
ddx:
NONE!
This is an Aunt Minnie!

Front 36

Back 36

Esophageal varicies

Findings:
Numerous thickened and irregular folds along the entire length of esophagus
Appearance may change with luminal distention
ddx:
Varicoid esophageal carcinoma

Front 37

Back 37

Esophageal traction diverticulum

Findings:
Focal triangular contour abnormality of the anterior mid-esophagus
Loss of normal mucosal pattern
ddx:
Mediastinal LAN
Metastatic (breast)
Infectious (TB)

Front 38

Back 38

Celiac sprue

Findings:
Mild small bowel dilation
Decreased number of normal thickness jejunal folds (< 5/inch)
Paradoxical increase of ileal folds = “jejunization”
Transient small bowel intussusceptions
Increased risk of lymphoma and carcinoma
ddx:
NONE!
This is an Aunt Minnie!

Front 39

Back 39

Linitis plastica

Findings:
Smooth narrowing of the gastric lumen with loss of normal mucosal pattern = “leather bottle stomach”
ddx:
Scirrhous gastric Ca
Metastatic disease
Breast, pancreas, ovarian
Lymphoma
syphilis
Crohn’s disease

Front 40

Back 40

Collar-button ulcers in ulcerative colitis

Findings:
Numerous outpouchings of contrast perpendicular to the lumen with a narrow neck and a board base = submucosal penetration = “collar-button ulcer”
Ahaustral, granular mucosa of the colon = UC
ddx:
Collar-button ulcers can occur with virtually any type of ulceration from any cause
This case, however, is an Aunt Minnie for UC!

Front 41

Back 41

Sclerosing cholangitis

Findings:
Cholangiogram shows multiple segments of smooth biliary narrowing
“shaggy” appearance of the CBD
Increased risk of cholangiocarcinoma
Causes:
Ulcerative colitis
Ascending cholangitis
AIDS cholangiopathy
Parasitic infections

Front 42

Back 42

Gastric leiomyosarcoma

Findings:
Large fundal mass protruding into the gastric lumen with an irregular central crater
ddx:
Leiomyoma
Gastric adenocarcinoma
Lymphoma

Front 43

Back 43

Familial adenomatous polyposis

Findings:
Innumerable small round and oval filling defects measuring approximately 2-3mm distributed throughout the colon = “carpet”
High risk of carcinoma
Prophylactic colectomy
ddx:
NONE!
This is an Aunt Minnie!

Front 44

Back 44

Pancreatic adenocarcinoma

Findings:
Splaying of the duodenal C-loop and mass effect on the gastric antrum
Underlying duodenal mucosa unaffected
ddx:
Pancreatitis
Lymphoma / LAN
Hematoma
Leiomyoma / leiomyosarcoma of the distal stomach

Front 45

Back 45

Esophageal web

Findings:
Thin horizontal filling defect along the anterior margin of the proximal esophagus
ddx:
NONE!
This is an Aunt Minnie!

Front 46

Back 46

Coned cecum

Findings:
Circumferential narrowing of the cecum with loss of the normal mucosal fold pattern
ddx:
Infectious
Tuberculosis
Amebiasis
Inflammatory
Crohn’s disease
Appendicitis
Neoplastic
Adenocarcinoma
Lymphoma

Front 47

Back 47

Paraesophageal hernia

Findings:
Hiatus hernia with a small paraesophageal component
If large enough, increased risk of gastric volvulus and strangulation
ddx:
NONE!
This is an Aunt Minnie!

Front 48

Back 48

Hypertrophic pyloric stenosis

Findings:
Barium study in an infant shows a tight stenosis of the gastric pylorus = “string sign”
ddx:
NONE!
This is an Aunt Minnie!

Front 49

Back 49

Meckel’s diverticulum

Findings:
Enteroclisis shows a single diverticulum along the antimesentic side of the distal small bowel
ddx:
NONE!
This is an Aunt Minnie!

Front 50

Back 50

Ischemic colitis

Findings:
Loss of normal mucosal pattern with segmental narrowing involving the splenic flexure
ddx:
Ulcerative colitis

Front 51

Back 51

Gastric polyps

Findings:
Multiple large (~1cm) smooth round filling defects throughout the stomach
ddx:
Hyperplastic
Inflammation
FAPS
Adenomatous
Hamartomatous

Front 52

Back 52

Gastric carcinoma

Findings:
Segmental narrowing of the antrum with loss of the normal mucosal pattern
ddx:
Peptic stricture
Lymphoma

Front 53

Back 53

Spigelian hernia

Findings:
LLQ hernia of the descending colon through the linea semilunaris (between the rectus and transverse muscles)
Large hernia orifice, less likely to obstruct
ddx:
NONE!
This is an Aunt Minnie!

Front 54

Back 54

Ulcerative colitis

Findings:
Ahaustral, granular mucosa of the rectum and sigmoid
Transverse colon spared
ddx:
Other inflammatory or infectious colitides
Ischemia (but very unlikely in the lower rectum)

Front 55

Back 55

Congenital lymphangiectasia

Findings:
Diffuse and regular small bowel fold thickening
Malabsorption & protein-loosing enteropathy
Fine micronodular pattern (1-2mm)
ddx:
Whipple’s disease
Secondary lymphangiectasia
Protein-losing enteropathy
Hypoalbuminemia
MAI

Front 56

Back 56

Malignant gastric ulcer

Findings:
Large ulcer of the gastric body
Malignant features:
Spiculated central crater
Thick heaped-up margin
Irregular radiating folds
ddx:
NONE!
This is an Aunt Minnie!

Front 57

Back 57

Metastatic melanoma

Findings:
At least two large “bull’s eye” lesions of the small bowel
ddx:
Other metastases
Breast
Lung
Pancreas
Lymphoma
Kaposi sarcoma

Front 58

Back 58

Benign gastric ulcer

Findings:
single small ulcer of the gastric fundus
benign features:
Well-defined crater
Thin, regular radiating folds
ddx:
NONE!
This is an Aunt Minnie!

Front 59

Back 59

Hypertrophic pyloric stenosis

Findings:
Barium study in an infant shows a tight stenosis of the gastric pylorus = “string sign”
ddx:
NONE!
This is an Aunt Minnie!

Front 60

Back 60

Papillary adenocarcinoma

Findings:
Abnormal enlargement of the papilla
ddx:
Edema from instrumentation or stone passage
Pancreatitis
Choledochocele
Polyp
Leiomyoma

Front 61

Back 61

Lymphoma

Findings:
multiple segments of small bowel narrowing with mild separation of the loops
numerous “bull’s eye” lesions
ddx:
GIST
Metastatic carcinoma

Front 62

Back 62

Peutz Jeghers syndrome

Findings:
numerous polypoid filling defects in the stomach and colon
ddx:
FAPS (Gardener’s)
Juvenile polyposis syndrome
Cronkhite-Canada

Front 63

Back 63

Scleroderma

Findings:
small bowel dilation = “pseudoobstuction”
Increased number of normal thickness folds (> 5/inch) = “hide bound” appearance
may see pneumatosis and pseudosacculations
ddx:
NONE!
This is an Aunt Minnie!

Front 64

Back 64

Reflux esophagitis &Schatzki ring

Findings:
mild narrowing of the lower esophagus
small hiatus hernia
circumferential ring at the squamo-columnar junction = “B” ring
symptomatic if lumen diameter < 13 mm
ddx:
NONE!
This is an Aunt Minnie

Front 65

Back 65

Adenomatous polyp

Findings:
Single round lesion along the lateral sigmoid wall projecting into the lumen
Possible ulcerated mucosa
ddx:
Adenocarcinoma

Front 66

Back 66

Rectal carcinoma

Findings:
Large “apple-core” lesion of the rectum
Loss of normal mucosal pattern
ddx:
NONE!
This is an Aunt Minnie!

Front 67

Back 67

Peptic stricture

Findings:
Tight stricture of the antrum
ddx:
Gastric adenocarcinoma
Lymphoma

Front 68

Back 68

Posterior gastric diverticulum

Findings:
Single diverticulum along the posterior gastric cardia
Normal mucosal pattern
No radiating folds
No clinical significance
ddx:
NONE!
This is an Aunt Minnie!

Front 69

Back 69

Gastric carcinoma

Findings:
Hourglass narrowing of the gastric body
Loss of normal mucosal pattern
ddx:
NONE!
This is an Aunt Minnie!

Front 70

Back 70

Radiation colitis

Findings:
Long segmental narrowing of the rectosigmoid colon
Focal sinus tract at the point of maximal narrowing
Loss of normal mucosal pattern
Evidence of prior abdominal surgery
ddx:
Crohn’s disease
TB
Mets
Lymphoma

Front 71

Back 71

Duodenal hematoma

Findings:
Pencil-thin luminal narrowing of the descending duodenum and bulb
ddx:
Duodenal tumor
Adenocarcinoma
Leiomyosarcoma
Lymphoma
Pancreatitis
Metastases

Front 72

Back 72

Radiation gastritis

Findings:
Hourglass narrowing of the gastric fundus
Complete loss of normal gastric mucosal pattern
ddx:
Crohn’s disease
? Caustic ingestion