A Pictorial Essay on Radiography of Swallowing and Esophageal Disorders

Abstract

Numerous abnormalities, both of congenital and acquired causes, can compromise the swallowing process and the ability of the esophagus to transmit the food from the mouth to the stomach in pediatric population. Patients often present a history of aspiration, dysphagia or feeding difficulties. The imaging evaluation typically begins with a fluoroscopic examination of the swallowing process and esophagus (esophagram), using either barium or water soluble contrast medium. This pictorial essay delineates the imaging features of normal anatomy and physiology of the swallowing and the esophagus, as well as the imaging features of common pediatric swallowing dysfunctions and various esophageal abnormalities. It is designed in order to assist radiologists in providing an appropriate diagnosis when confronted with a suspected disease in this anatomic region, and when appropriate, what additional testing to recommend. It is also designed to inform pediatricians about the wealth of diagnostic information that may be collected when performing an esophagram; a relatively simple radiographic examination. Conclusion -Radiographic imaging of swallowing and the esophagus remains the primary imaging modality in patients with a history of aspiration, dysphagia and feeding problems. It offers valuable diagnostic information related to anatomy, morphology and peristalsis.

Contrast Radiography: Still the 'Gold Standard' for Assessment of Swallowing and Esophageal Disorders in Children

“…As Dr. Ključevšek highlights in their article, for correct interpretation of the findings it is extremely important that radiologist is familiar with normal anatomy and physiology of the esophagus as well as with appearance of numerous pathological conditions (2,3). Before starting the examination, it is also very important to be aware with the child's history of feeding, symptoms and clinical condition.…”

“…The equipment should provide diagnostic fluoroscopic image quality and recording capability (radiographs, video, or digi-tal) (4). The equipment adapted for neonates and infants allows safer child immobilization and proper patient positioning, more accurate limitation of the field of view (2). The amount and type of contrast material given are determined by the child's age and the indications for the study, but should always be delivered in a manner that is appropriate for the patient's age.…”