Fluoroscopic Swallowing Examination: Radiologic Findings and Analysis of Their Causes and Pathophysiologic Mechanisms.

Dysphagia is a common symptom in the general population, and its prevalence increases with patient age. The deterioration of swallowing function has many acute and chronic causes, including cerebrovascular and neuromuscular diseases, radiation, and surgery. In an elderly population, diagnosis and treatment of swallowing abnormalities is a high priority because it improves the patient's quality of life and helps them to avoid medical complications. Fluoroscopic swallowing examinations and modified barium swallow studies are the most used and most reliable diagnostic procedures to evaluate swallowing disorders. Functional anomalies include disturbances of the oral preparatory, oral propulsory, and pharyngeal phases of swallowing as premature spillage from the mouth, nasal regurgitation, delayed initiation of pharyngeal swallowing, incomplete displacement of the hyolaryngeal complex, abnormal epiglottic tilt, incomplete laryngeal closure, and pharyngeal dysmotilities. Anatomic abnormalities of the pharynx include diverticula, benign strictures, and tumors. The abnormalities diagnosed on the basis of fluoroscopic examination have a variety of treatment strategies, and the choice of treatment depends on the cause of the anomaly and its pathophysiologic characteristics. The radiologist's interpretation of these characteristics is crucial to therapeutic decision making and achieving the best patient outcomes. Online supplemental material is available for this article. ©RSNA, 2021.

Imaging findings of successful and failed fundoplication.

Postoperative imaging findings contribute to the diagnosis of successful and failed fundoplication procedures. Gastroesophageal reflux disease, a common illness in the United States, is primarily treated medically but may require surgery if there are persistent symptoms or reflux complications despite medical treatment. Laparoscopic Nissen fundoplication has become the most used and successful surgical antireflux procedure since its introduction in 1991. Radiologists should understand the anatomy of the esophagogastric junction, antireflux and esophageal protective mechanisms, and preoperative radiologic findings that contribute to selection of the surgical technique, as well as the most commonly used antireflux operations and their indications. Barium examination and computed tomography of the thorax and abdomen play an important role in the follow-up of patients with gastric fundoplication, including evaluation of surgical effectiveness and detection and characterization of postoperative complications. Failed fundoplications are classified into six types: tight Nissen, incompetent repair, disruption of the wrap, stomach slippage above the diaphragm, slipped Nissen, and transdiaphragmatic wrap herniation. Classification is based on radiologic visualization of the obstructed esophageal lumen, recurrence of gastroesophageal reflux, integrity and location of the gastric wrap, stomach slippage, and recurrence of hiatal hernia. Imaging findings are useful in detecting complications, providing anatomic information to identify the cause of surgical failure, and selecting appropriate medical or surgical management.

Acquired constricting and restricting lesions of the descending duodenum.

The descending duodenum is a structure with distinct pathologic processes and anatomic relationships that requires a systematic approach to the differential diagnosis. Because of its tubular shape and fixed position in the retroperitoneum, both intrinsic duodenal and juxtaduodenal diseases are capable of producing luminal narrowing and obstruction. Duodenal lesions may be located in the mucosa or submucosa. Extraduodenal lesions may originate in adjacent structures--such as the pancreas, liver, gallbladder, colon, and lymph nodes--or from other retroperitoneal structures. Causes of duodenal obstruction include intraluminal masses, such as bezoars; duodenal inflammation, such as as peptic ulcers and Crohn disease; hematomas; and benign or malignant mucosal and intramural tumors. Pancreatic inflammation; tumors; and extrinsic compression caused by gallbladder processes, hepatic masses, retroperitoneal fluid collections, and tumors, including lymphoma, may produce duodenal obstruction. Abdominal radiography, barium studies, multidetector computed tomography, magnetic resonance imaging, and positron emission tomography may be used to depict and characterize duodenal strictures. Integration of imaging, clinical, laboratory, and endoscopic findings plays a major role in establishing a diagnosis of obstructive duodenal strictures.

The most characteristic lesions and radiologic signs of Crohn disease of the small bowel: air enteroclysis, MDCT, endoscopy, and pathology.

This pictorial essay describes the most characteristic lesions and radiologic signs of Crohn disease of the small bowel: nodular lymphoid hyperplasia, abnormal mucosal folds, villous pattern, aphthous ulcerations, linear ulcerations, cobblestone pattern, string sign, target sign, comb sign, creeping fat, sinus tracts, fistulas, and abscesses. Each description includes the definition, a correlation with the pathologic findings, an explanation of the possible physiopathologic mechanism, sample radiologic images with air enteroclysis or MDCT, the correspondence with the endoscopic findings when possible, and a list of differential diagnoses.

Blunt traumatic injuries of the lung parenchyma, pleura, thoracic wall, and intrathoracic airways: multidetector computer tomography imaging findings.

This pictorial review discusses multi-detector computed tomography (MDCT) cases of non-vascular traumatic chest injuries, with a brief clinical and epidemiological background of each of the pathology. The purpose of this review is to familiarize the reader with common and rare imaging patterns of chest trauma and substantiate the advantages of MDCT as a screening and comprehensive technique for the evaluation of these patients. Images from a level 1 trauma center were reviewed to illustrate these pathologies. Pulmonary laceration, pulmonary hernia, and their different degrees of severity are illustrated as examples of parenchymal traumatic lesions. Pleural space abnormalities (pneumothorax and hemothorax) and associated complications are shown. Diaphragmatic rupture, fracture of the sternum, sternoclavicular dislocation, fracture of the scapula, rib fracture, and flail chest are shown as manifestations of blunt trauma to the chest wall. Finally, direct and indirect imaging findings of intrathoracic airway rupture and post-traumatic foreign bodies are depicted. The advantage of high quality reconstructions, volume rendered images, and maximal intensity projection for the detection of severe complex traumatic injuries is stressed. The limitations of the initial chest radiography and the benefits of MDCT authenticate this imaging technique as the best modality in the diagnosis of chest trauma.

Role of imaging in the diagnosis of the superior mesenteric artery syndrome.

The purpose of this report is to describe the role of imaging in the diagnosis of the superior mesenteric artery syndrome. A review of clinical symptoms, diagnostic imaging, and patient management of superior mesenteric artery syndrome constitutes the core of this report. Images of upper gastrointestinal series, multislice CT, and CT angiography with multiplanar reconstruction illustrate their usefulness in the diagnosis of 3 patients with superior mesenteric artery syndrome.