Imageological Diagnosis of the GI

Common Diseases

Zhang Huiyu
esophageal varices
Esophageal varices
 Pathogeny and pathology ：
a complication of portal hypertension
cirrhosis of liver → portal
hypertension(PV↑)→blood obstructed in portal
vein →flow into latteralcirculation→varices of
submucosal and periesophageal v. →azygos
vein→SVC
clinical symptoms ： hematemesis and melaena
Esophageal varices

X-ray barium swallow ：

Early stage ：
 mucosal folds is widened slightly in the
end of the eso.
 The wall of the eso is irregular slightly.
 The barium meal passes through eso
without obstruction.
 Esophageal varices
Advanced stage:
 Mucosal folds are widened obviously, showing lucent,
worm-like or bead-like filling defects.
 Widened lumen of eso. and sawtooth contour of eso.
 The barium meal passes through slowly.
 The fundus varices:grape-like or multiple polypoid
filling defects.
esophageal carcinoma
Esophageal carcinoma
 Epidemiology ： a common disease in
Henan province
 Pathology ： squamous cell
,adenocarcinoma
early stage ： protruded type,superficial
type,excavated type
advanced stage ： medullary type,
fungating type, ulcerative type, scirrhous
(strictured) type, intracavitary type
 Clinical symptom ： difficult swallow
 diagnosis ： imaging,endoscopy
Esophageal carcinoma

X-ray findings of early esophageal

carcinoma ：
● Mucosal folds are widened,tortuous,coarse
and interrupted
● Small crater, 2-0.4cm in size
● Small filling defect, 0.5cm in size
● Reduced flexibility of the local wall of
esophagus
 Esophageal carcinoma
X-ray findings in advanced stage:
• Destruction,interruption or
disappearance of mucosal folds.
• Rigidity of the wall of eso. and
obliteration of peristalsis.
• Narrowing of eso. And outlet

obstruction.
 Esophageal carcinoma
• Medullary type: irregular stricture, long range,
10cm in length
• fungating type: irregular filling defect and
lateral stricture
• ulcerative type: meniscus sign
• scirrhous type:localized and annular stricture.
• intracavitary type:giant filling defect
Imageological diagnosis
of the gastric diseases
gastric ulcer
The main X-ray findings of round ulcer
Crater
projecting beyond the lumen of the
stomach. <2cm
in profile ： nipple-like or triangular
protrusion
en face: a round collection of barium
Hampton’s line
lucent line at the edge of niche, 1-2mm
width
The main X-ray findings of round ulcer

collar sign :
a lucent zone at the edge of ulcer, 0.5-1.0cm in
width
Narrow neck sign ：
the edge of ulcer is very narrow like a long neck

Protrusion around nitch:

a lucent zone with the same width around the
nitch
Radiating mucosal folds reaching the edge of
niech
Imageological diagnosis
of the gastric carcinoma
Gastric Carcinoma

Pathogeny ：
external cause: environment,diet
internal cause: many kinds
Pathology ：
early stage (Ⅰ 、Ⅱ、Ⅲ )
advanceed stage (BorrmannⅠ-Ⅳ)
 Diagnosis :imaging endoscopy
 Gastric Carcinoma
The common x-ray findings of advanced gastric carcinoma
 Irregular filling defect in the stomach
 Narrowing of stomach and rigidity of the wall of stomach
 Meniscus syndrome ：
ulcer: irregular shape, meniscus-like, with even outer edge and
irregular inner edge
ulcer: in the outline of stomach
periphery of ulcer: a lucent zone with the different width around
ulcer ， nodule on it is often seen
 Destruction , interruption and disappearance of mucosa
 Loss of peristalsis of the involved stomach
 Imageological
Diagnosis of the
Small Intestine
Imageological Diagnosis
of Duodenal diseases
 Duodenal ulcer

location ： bulb, 95%. A few , postbulb

pathology ：
single, 1-10mm in size ， round
,deformed bulb ， inflammatory edema
and fibrosis on the periphery of ulcer
symptom ： epigastric pain with
regularity and rhythm
diagnosis ： imaging endoscopy
 Duodenal ulcer

Direct signs ：
Niech or crater ：
en face ： the ulcer shows round opaque with
lucent zone around the its periphery and radiating
mucosal folds toward the edge of niech
in profile ： nipple-like or lapper protrusion
Deformed bulb ： (due to scar)
unilateral or lateral
Duodenal ulcer

Indirect signs ：
accelerating evacuation
Pyloric spasm
Hypersecretion of stomach
Fixed tenderness on bulb
Imageological Diagnosis
of the Large Intestine
 Carcinoma of the large intestine

pathology ： hyperplasia type

(54.2%),ulcerative type (28.1%),infiltrative type
symptoms ： obstraction,having blood in stool
diagnosis ： imaging ,endoscopy
 Main X-ray findings of advanced large intestine

Hyperplastic(polypoid)type ：
Irregular filling defect projecting into the
lumen of the bowel
 eccentric stricture
Rigidity of the wall of intestine,destruction
of mucosa and loss of peristalsis
 Main X-ray findings of advanced large intestine

Ulcerative type ：
Large and irregular ulcer seen in the lumen of
intestine
A lucent zone with different width around the
ulcer
Rigidity of the wall of intestine , destruction of
mucosa, loss of peristalsis
Main X-ray findings of advanced large intestine

Infiltrative type ：
Irregular and annular stricture ,
obstruction
Destruction of mucosa, rigidity of
the wall of intestine, loss of
haustration