BARIUM SWALLOW
BY
MATHEW ABUBAKAR
DEPARTMENT OF MEDICAL
RADIOGRAPHY
UNIVERSITY OF MAIDUGURI
TABLE OF CONTENTS
INTRODUCTION
BRIEF ANATOMY OF THE OESOPHAGUS
IMAGE APPEARANCE
TECHNIQUES
CONCLUSION
REFERENCES
INTRODUCTION
Barium swallow is a radiological investigation which involve
the use of contrast media to outline the upper GIT.
Barium opacifies and best demonstrate the anatomy of the
esophagus.
Barium swallow with fluoroscopy provide a useful alternative to
evaluate esophageal motility.
Double contrast when employed gives mucosal details.
On PA the cervical esophagus is seen to curve slightly to the left.
On a lateral view, the esophagus is seen anterior to the cervical
spine.
BRIEF ANATOMY
It is a muscular, tubular structure about 25cm long.
The majority of its course is within the thorax.
Begins from cricoid cartilage (c5/c6) as continuation of oropharynx
to gastroesophageal junction (T10).
It has cervical, thoracic and short intraabdominal portions.
It pierces the diaphragm approx. 2.5cm to the left of the midline to
enter the abdomen.
BARIUM SWALLOW
Cricopharyngeus muscle (4a)
Aortic knuckle(1b)
Left main bronchus (2b)
TECHNIQUE
BARIUM SWALLOW
Examination of esophagus using barium.
INDICATIONS
a) Dysphagia
b) Unexplained anaemia
c) Pain on swallowing (as in 1 above).
d) Assessment of tracheo-oesophageal fistulae
(congenital or acquired).
e) Assessment of the site of perforation (traumatic or
neoplastic).
CONTRA INDICATION
a) None
CONTRAST MEDIA
a) Barium sulphate,100 ml (or more, as required)
b) Gastrografin
c) LOCM (approx. 350 mg I/ml).
EQUIPMENTS
a) fluoroscopy and spot film device
PATIENT PREPARATION
a) None (but as for barium meal if the stomach is also to be
examined).
PRELIMINARY FILM
a) A control film is advised prior to a water-soluble study if
perforation is suspected.
TECHNIQUE
a) The patient is in the erect RAO position to throw the
oesophagus clear of the spine.
b) An ample mouthful of barium is swallowed.
c) spot films of the upper and lower oesophagus are taken.
d) Oesophageal varices are better seen in the prone RPO
position, as they will be more distended.
e) If rapid serial radiography is required, it may be
performed in the right lateral, RAO and PA positions.
AFTERCARE
a) None if no complication
COMPLICATIONS
a) Leakage of barium from an unsuspected perforation
b) Aspiration.
REFERENCES
Chapman and Nakielny (2009); A guide to radiological
procedure. 5th ed. Saunders Elsevier 2009
Indebir Singh (2002); Essentials of anatomy. 1st ed.
Jaypee, 2002.
