Saeed Rad, M.D.

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Radiograph demonstrates bowel containing contrast within the chest, within the pleural cavity consistent with a pleuroperitoneal hernia.

Pleuroperitoneal hernias typically occur posteriorly and are a result of a posteriorly located defect when there is a failure in closing the pleuroperitoneal membrane closure while in utero. Bowel, retroperitoneal structures may prolapse through the defect into the pleural space.

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Image IQ Quiz: What Do You See on This Bowel X-ray?

Large filling defect with irregular margins seen on this upper GI series on fluoroscopy.

On upper GI series, any filling defects projecting from the wall of the stomach may be seen. Ulceration and cavitation may also be present. Margins of the filling defect may be smooth or irregular.

Patient presents for upper GI series with this finding... What is your diagnosis?


Image IQ Quiz: What's On This Upper GI Series?

 Wall thickening of the ileum is seen on follow-through of GI series on fluoroscopy. Findings are consistent with inflammation of the terminal ileum in Crohn’s disease.

 In the small bowel, in Crohn’s disease, there can be skip lesions and discrete ulcers. The terminal ileum is usually affected first, but remaining segments of the small bowel are also commonly affected. On fluoroscopy, on small bowel follow-through, mucosal ulcers can be seen and widely separated bowel loops of bowel can also be seen due to fatty proliferation (“creeping fat”). There can also be the “string sign” seen, which is narrowing or spasm of small bowel segments. Look for partial bowel obstructions and also pseudodiverticulum formation.

What is causing this appearance on small bowel GI series follow-through?

Image IQ Quiz: What Do You See on This Small Bowel GI Series?

 Bird-beak narrowing as seen on this barium swallow study. The absence of air in the expected location of the gastric bubble on frontal radiograph is also seen here.

 There is often loss of esophageal peristalsis and loss of relaxation of the LES – lower esophageal sphincter. As a result there is an obstructive process resulting in food stasis and marked proximal dilatation of the esophagus. The differential diagnosis is secondary achalasia or pseudochalasia from possible malignancy is also a diagnostic consideration.

What is causing this appearance on this barium study?

Saeed Rad, M.D.

Articles

Image IQ Quiz: What Do You See on This Bowel X-ray?

Image IQ Quiz: What's On This Upper GI Series?

Image IQ Quiz: What Do You See on This Small Bowel GI Series?

Image IQ Quiz: What Do You See on This Barium Study?