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1062 Barium Esophagram, Dynamic

Barium Esophagram, Dynamic
VetBooks.ir

○ If plain films are diagnostic (i.e., mega-
Difficulty level: ♦♦♦
esophagus [p. 642]), the study may be are not included in the primary beam) is
paramount.
Synonyms unnecessary.
Barium swallow, fluoroscopic esophagram • Prepare contrast agents Procedure
○ Barium Dynamic esophagram, barium:
Overview and Goal ■ Liquid barium in appropriately sized • Survey films of thorax and cervical region
To administer a contrast agent per os and syringe (already described in preparation).
observe the oral and pharyngeal phases of swal- ■ Liquid barium mixed with canned • Position animal in right lateral recumbency
lowing and esophageal transit using fluoroscopy. food. Only a small amount of barium (if a C-arm fluoroscopy unit is used, it may
The goal of the study is to define abnormalities (<5 mL) is needed, which keeps the be possible to place the animal in sternal
of swallowing and/or esophageal transit. solid consistency of the food. recumbency or standing and use a horizontal
○ Non-ionic iodinated contrast agent beam) with appropriate restraint; special
Indications ■ Iohexol, iopamidol, ioxaglate com- holding units for such studies available in
Functional abnormalities of swallowing pounds some referral settings).
(dysphagia [p. 277], abnormal esophageal ■ Liquid diluted 1 : 1 • Activate fluoroscopy unit briefly to determine
motility). Can be used for evaluating mechanical ■ Diluted liquid is mixed with canned correct positioning and collimation.
abnormalities (mass, foreign body, extrinsic food. • Activate the videorecorder.
compression), but a static esophagram is usually • Personnel needed for procedure (restraint • Administer liquid barium PO 2-3 mL for
sufficient for this purpose. and administration of contrast). This may a cat and 5-10 mL depending on the size
require two to three people, depending on of the dog), and activate fluoroscopic unit.
Contraindications animal’s size and temperament. Image the oral and pharyngeal phases of
• Evidence or risk of esophageal perforation. • All personnel should have appropriate lead swallowing (progression of barium from
Risk of esophageal perforation may be protective apparel (aprons, thyroid shield, mouth to esophagus) and esophageal transit
present in patients with a sharp/irregular gloves). (progression from upper esophageal sphincter
esophageal foreign body or a foreign body • Paper towels or other barrier drapes to to stomach). Repeat 2-3 times even if no
that is present for longer than 24 hours. limit excess contrast agent on table and abnormality is defined.
• Megaesophagus: not an absolute contrain- animal • Spot film any areas of abnormality; lateral
dication, but the study is not needed for views are generally sufficient.
diagnosis, and there may be a risk for aspira- Possible Complications and • Administer barium and canned food mixture
tion of the contrast agent. NOTE: Exception Common Errors to Avoid PO. Appropriately sized food balls (1-3 cm in
may be for diagnosis of lower esophageal • Aspiration of contrast agent: study is always diameter) may be fed to the animal or placed
achalasia as a cause of megaesophagus. begun with a liquid contrast agent and no in the mouth. Activate fluoroscopic unit,
food. Animals with disorders requiring these and image the oral and pharyngeal phases of
Equipment, Anesthesia evaluations may be prone to dysphagia and swallowing (progression of barium and food
• Contrast agent aspiration of contrast. If a small amount of from mouth to esophagus) and esophageal
○ Liquid barium (30% weight/volume and liquid contrast agent is aspirated, it can be transit (progression from upper esophageal
higher density) coughed up. If the animal aspirates liquid sphincter to stomach). Repeat 2-3 times even
○ Iodinated contrast agent: contrast agent, the study should be aborted. if no abnormality is defined.
Non-ionic (iohexol, iopamidol, ioxa- • Ionic iodinated contrast agents: use of these • Spot film any areas of abnormality; lateral
■
glate compounds) agents is CONTRAINDICATED because views are generally sufficient.
Diluted 1 : 1 with water clinically significant, potentially fatal pulmo- Dynamic esophagram, non-ionic iodinated
■
• Highly palatable canned food nary edema can occur if they are aspirated. contrast agent:
• Syringes for barium administration Ionic agents include diatrizoate, iothalamate, • This study may be performed if esophageal
• Bowl and utensil for mixing barium and and iodamide compounds. rupture is suspected or if endoscopy is
food • Non-ionic iodinated contrast agents can be to be performed immediately after the
• X-ray unit used if there is a suspicion of but not definite esophagram. If an esophageal perforation
○ Fluoroscopic capability evidence of esophageal perforation. is suspected, a static esophagram is usually
○ Spot film capability • Leakage of contrast agent: evidence or risk performed instead, using a non-ionic iodin-
○ Videorecording capability of esophageal perforation is considered a ated compound.
• Protective clothing (lead aprons, gloves, contraindication for this study. If contrast • The dynamic esophagram using a non-ionic
thyroid shields) for personnel agent leakage is suspected at any time, the iodinated contrast agent follows the same
• Paper towels or similar for cleanup of barium study should be aborted. procedure as the barium esophagram.
on animal and x-ray table • Assuming the procedure is not stopped
because of aspiration of contrast agent or Postprocedure
Anticipated Time evidence of leakage of contrast agent, it is Rarely, GI signs may occur but are typically
15-20 minutes important to perform the study with liquid mild and self-limited.
contrast agent and liquid contrast agent
Preparation: Important mixed with food to give as full an assessment Alternatives and Their
Checkpoints of esophageal function as possible. Relative Merits
• Survey films of thorax and cervical region • Fluoroscopic procedures involve a substantial Static esophagram: a static esophagram (admin-
○ If contraindications are present (as previ- radiation dose to the animal and to person- istration of barium and obtaining routine films)
ously mentioned), study should not be nel. Radiation safety (e.g., proper protective can be used in place of a dynamic study for
performed. clothing, collimation so that personnel certain indications. A static study does not

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