Check the performance of esophageal Imageology (a) x-ray examination
1. early esophageal cancer in the X-ray X-ray examination is an important means of early diagnosis of esophageal cancer is one, but the X-ray findings of early esophageal cancer is very obvious, and are easily missed diagnosis and misdiagnosis. According to 58 cases of surgical resection of early esophageal cancer, the main X-ray findings are as follows:
(1) filling defect limited to the superficial edge of the lesion showed filling defects in rough, shallow, or the edge of a small depression than finishing. Esophageal endoscopic lesions were macular uplift, mucosal erosion. Mostly plaque gross specimen, some of the erosive lesions of the erosion of the margin slightly elevated, but also can cause changes in superficial filling defect.
(2) changes in mucosal folds of the mucous membrane is the most common signs of change, including the mucosal fold thickening, tortuous, interrupt, damage and radiation beat and other changes, which the mucosal fold thickening and tortuosity of the most common. Often has a distorted mucosal pattern like the dotted line break changes. Influx in the mucosa of the cases, the performance of number of articles mucosa together some point, like a benign mucosal changes around the ulcer, and some mucous membranes were cross-together. Esophageal mucosal lesions microscopy rough, erosion, with granular or small papillary changes, plaque formation and some local uplift or masses. Gross specimen for the plaque or erosive. Plaque-type, x ray changes seen in addition to mucous membrane, there are small particles or plaque-like filling defect, the lesion can be seen cutting bit uneven esophagus. Erosive type, x-ray findings of mucosal changes in addition to single or multiple small Kanying outside the visible.
(3) small ulcers are relatively rare. Single or multiple small lesions visible Kanying, near the mucosal fold thickening and a disruption.
(4) papillary filling defect in the X ray showed the esophageal wall or papillary polypoid filling defect, about the size 1Xl3X1Ccm2); tumor with clear boundary, but not quite finishing. Tangential position can be seen when the broad mass base of the wall defect, the formation of irregular depression. Polypoid mass in front view, barium clearly outlines the boundaries of the surface mucosa is not the whole mass or disappear, mild mucous membrane around the whole. Mass surface can be a small Kanying. Esophageal endoscopic papillary or polypoid bulge, highlighted mucosal surface. Rough mucosa, may have erosion, congestion, or shallow ulcers. Gross specimen, the tumor surface uplift, polypoid. X-ray diagnosis of early esophageal cancer areas of understanding: first of all have skilled technique, the inspection process to be patient, meticulous, from the perspective of esophageal different perspective observation. Found after lesions, lesions in the best position display camera. If perspective was not found lesions of esophageal mucosa should be taken full-chip and double-contrast film, and then carefully observe the pictures. We are based on case analysis, hypotonic double contrast photographic observation of esophageal wall in the diastolic level, to understand whether the finishing wall and found a small tumor, showing lesion morphology, lesion contour and scope, the film is superior than mucosal . The patients in the performance of finishing mucosal carcinoma or nodular lesions uplift, with clear boundaries; or mucous membrane, or mesh of fine feathery change, be mixed granular barium shadow; or mucosa was the marble-like pattern, and to outline the uplift of the plaque; tangential position meet the lesion with a shallow depression, was basically a small sawtooth-like or finishing. Showed a submucosal papillary carcinoma can be uplifted, not only the entire surface may have superficial ulcers, lesions of basal tangential bits wide, the wall defect in the formation of irregular depression; or performance of dike-like uplift of the lesion, the wall tangential position shows the formation of shallow depression In the filling defect; or showed a small ulcer, border uplifted filling defect.
2. In the performance of advanced esophageal X-ray
(1) medullary lesions appear as irregular filling defect, the upper and lower edge of the transitional state of the normal esophagus was sloping, often of varying sizes Kanying. Stenosis, barium through obstruction. Lesions of soft tissue mass was often seen.
(2) obvious fungating filling defect, the upper and lower curved edge, the edge sharp, clear boundaries with the normal esophagus, can have superficial ulcers. Mucosal lesion damage. Barium Flow obstructed.
(3) ulceration Kanying mainly for large, visible Kanying depth in the tangential position within the esophagus, and even highlight the contours of the tube, the ulcer edge of the uplift of those who often appears as a half levy. General obstruction is not obvious.
(4) narrowing the type of lesion was circular or funnel-shaped luminal stenosis, extent of disease is shorter, generally about 3cm, involving the esophagus for the week. Disappearance of the local mucosa, obstruction of a serious, significant expansion of the upper esophagus.
(5) the length of cavity lesions between the majority of the 5-10cm. Lesion lumen enlarged, fusiform expansion, the most wide and 7cm. Most lesions showed a large polypoid filling defect. Tumors were nodular, spherical, fusiform or sausage-like, broke into the esophageal lumen. Sharp upper and lower lesions clear. Esophageal lesion edge defects, incoherent, mucous membrane lesions are not neat; barium patchy distribution of irregular, uneven. Few cases have Kanying. Although most cases of large tumors, but not serious obstruction of the lumen, sometimes widened esophageal lesions caused by mediastinal shadow.
Medullary type than to the most common, followed by mushroom umbrella, the other less common types. There are also a few cases from the X line can not be classified.
3. esophageal special X-ray
(1) multiple esophageal cancer and esophageal cancer, more than repeat the upper digestive tract cancer is the same in the esophagus or has occurred in different parts of the two tumor; upper digestive tract cancer is repeated esophageal or gastric cardia cancer combined. X-ray examination is the discovery of multiple esophageal duplication of upper digestive tract cancer and cancer of the important means of treatment for clinical decision has great significance. Medical Oncology Hospital, 1958 —- 20 years of patient diagnosed in 1977, 16,064 cases of esophageal cancer, were found in esophageal cancer and multiple repeat upper gastrointestinal cancer in 38 cases, accounting for 0.24%. High incidence of esophageal cancer in Linxian of Henan Province in the Yao village commune 1970_1978 627 cases of esophageal cancer in esophageal cancer and multiple repetition of upper digestive tract cancer, 21 cases, accounting for 3.35%, of which more than esophageal cancer, 11 cases of esophageal cancer combined cardiac 8 cases, 1 case of esophageal cancer combined. X ray found a tumor in the esophagus contrast, are often easy to neglect that has confirmed the existence of a second cancer. So for esophageal imaging, we should pay careful attention to check the esophagus and cardia of each section to avoid missing multiple lesions, affect clinical treatment. High incidence of esophageal cancer, esophageal cancer while preparing for surgery confirmed cases should be further for gastrointestinal imaging to rule out the possibility of cancer combined.
(2) esophageal cancer complicated by esophageal achalasia Medical Oncology Hospital from 1962_1990 11,921 cases of esophageal cancer were treated, including 7 cases complicating achalasia, accounting for 0.05% of the age range 30-54 years of age, history of achalasia 7 – 20 years, median 14 years. Achalasia is a functional disorder of the disease, can occur at any age. As the food long in the esophagus, often complicated by esophagitis, esophageal can
cer can be complicated. Reported esophageal achalasia complicated by more in the lower section of the 7 patients in this group, 6 cases occurred in the previous paragraph. Lead to different parts of the tumor incidence of complaints when the treatment is different. Those in the lower, often causing increased difficulty swallowing, pain, vomiting, etc.; occurred in the previous paragraph are often a direct violation of the trachea caused by the spread of cough, hoarseness or even esophageal – tracheal fistula. Of achalasia patients for X-ray examination should be done carefully esophagus full of double contrast, multi-axis radiography, angiography should be carefully prepared before, three days into the liquid diet, if necessary, to be pumping, clean esophagus residues in order to avoid missing concurrent cancer.
Imageology check the performance of esophageal cancer 4. Perforation of esophageal cancer complicated by X-ray findings of esophageal perforation is a serious complication of esophageal cancer, the prognosis is poor. When the suspected perforation, should be sterile or Lipiodol contrast barium paste. Esophageal cancer cases in the previous paragraph, such as found in contrast barium into the trachea, should be noted that identification is a contrast agent upstream from the throat into the trachea, or perforation.
We analyzed 350 cases of esophageal perforation within 1 month before the X-ray photographs, that before the lesion had perforated spines prominent, Kanying formation, diverticulum-like change, and vascular distortion and mediastinal go far into the angle change. If the penetration of the trachea or bronchus, the formation of esophageal – tracheal or esophageal fistula – bronchial fistula, barium into the bronchial as bronchography. If the penetration of the mediastinum is the formation of irregular deposits outside the esophageal lumen collar area.
Check the performance of esophageal Imageology (a) x-ray examination