Computed tomography of the esophagus to diagnose the digestive tract

 

  • Conclusion
  • The most visited doctor in the clinic – gastroenterologist. Problems of the digestive system occur more frequently than every second inhabitant of the planet. Cause become different factors: overeating, eating poor quality food, love of coffee and alcohol, Smoking, stress, infection, etc. To the specialist the patients are coming with complaints of heartburn, belching, feeling of lump in throat, pain in the epigastrium and behind the sternum. These symptoms are characteristic for problems of the esophagus, and may indicate various diseases. Sometimes similar symptoms occur with the localization of the pathology in other organs: the spine, heart and thyroid gland.

    In connection with the anatomical features of this organ in the Arsenal of physicians not so much the diagnostic methods to establish the correct diagnosis. In some situations it is impossible to do without performing computed tomography (CT).

    • Esophagitis is a chronic inflammation.
    • Barrett’s esophagus – change (e-transformation) of the structure of the lining epithelium. Dangerous progression, degeneration into a malignant tumor.
    • Benign tumors – adenomas, polyps, hemangiomas.
    • Malignant neoplasms – cancer and adenocarcinoma.
    • Diverticulosis – the formation of «pockets» which delayed swallow food.
    • Diaphragmatic hernia – displacement of the stomach and lower third of the esophagus in the thoracic cavity.
    • Acute injury: chemical (burns acids and alkalis) and mechanical damage by foreign objects.

    Diagnostic methods

    Due to anatomical location, in the Arsenal of physicians not many ways to diagnose these diseases. Typically, there are four instrumental methods:

    1. Esophagogastroduodenoscopy (EGDS). Held endoscopic camera that is inserted inside the tube and, taking picture on a camera, projected onto a monitor screen.
    2. Radiography with contrast (Rg). The patient taking an oral contrast substance that is absorbed, highlights the contours of the body on x-ray.
    3. Ultra sound examination (sonography). The examination is carried out using a special sensor, which emits ultrasonic waves, inspection passes through the skin.
    4. Computed tomography (CT). A diagnostic method based on the use of x-ray radiation. The x-ray beam enters the body spiral around the body of a man inside the machine. In this way, the image is obtained in the form of a thin transverse slices.
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    Table 1. Comparative characteristics of diagnostic procedures.

      Endoscopy Rg with contrast Ultrasound CT
    Examination of the mucous membrane Reveals any abnormality of the Detects only gross pathology Detects only gross pathology Detects only gross pathology
    The involvement of neighbouring systems and organs Not informative Uninformative Highly informative Highly informative
    Regional lymph nodes Not informative Not informative Highly informative Highly informative
    The sample of tissue sampling for microscopic analysis Possible Impossible Impossible Impossible
    Unpleasant or painful sensations during the execution of Expressed, a common cause for failure of the procedure Arise from the ingestion of barium No No

    Despite the apparent similarity of computed tomography and ultrasound in relation to diagnostic capability, the KTS have a distinct advantage: often to make the correct diagnosis the physician needs to repeatedly look at pictures and discuss them with colleagues of another specialty, ultrasound such possibility does not give.

    In what diseases of the esophagus important data CT

    Tumors

    In the esophagus there are two types of oncological processes:

    • Benign tumors are detected rarely – not more than 5% of the total number of tumors. These include papillomas, lipomas, adenomas.
    • Malignant tumors – squamous cell carcinoma and adenocarcinoma make up the remaining 95%.

    To diagnose and assess the stage of the cancer process, CT is the most accurate method!

    This is due to the fact that all types of tumors can grow in the lumen of the esophagus to spread inside the wall or grow outward (into the chest cavity). The same tumor can grow in several directions. Malignant tumors are able to grow in other organs and lymph nodes to metastasize.

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    CT, by performing layer-by-layer scanning of the chest, will determine:

    • The degree and extent of the constriction of the lumen of the esophagus
    • The involvement of neighboring systems, the connective tissue of the mediastinum and lymph nodes
    • The presence of compression of blood vessels and nerve fibers

    To answer these questions may not endoscopy and radiography. Informative will be the ultrasound, but his obvious drawback — sees pathological process only specialist performing the study. In the diagnosis and planning subsequent treatment of cancer usually requires the consultation of several specialists, each of them needs to see a picture of what is happening inside the body. Such opportunity is given only the image captured by the computer tomograph. In addition, the diagnostic value of ultrasound is in direct proportion to the skill of the doctor, it is carried out.

    Diverticulosis

    Diverticula arise for two reasons: congenital weakness of the muscular wall or due to chronic aggressions (food, regurgitation of gastric contents, acid). They come in single and multiple. To see the diverticulum can the specialist performing the endoscopy, visible and x-ray and ultrasound. Diverticulosis may not manifest itself, but there are cases of suppuration and even of perforation (violation of the integrity of the wall). The perforation can be one of the reasons for the development of mediastinitis (inflammation of the mediastinum) is a serious life-threatening complications. If there is a suspected perforation of the diverticulum, the x-ray is contraindicated, as the barium through the tissue defect will fall into the chest cavity. Endoscopy will only see the entrance to the pocket, the lumen narrow for the passage of the gastroscope. And only the implementation of KT will allow to give a complete picture of the diverticulum and surrounding tissues.

    Chemical burns and mechanical damage

    Exposure to strong acids and alkalis lead to burns of the esophagus and narrowing (stricture) of its lumen. Conducting endoscopy and x-rays in these conditions is contraindicated. If surgery is planned of begerovaya (restoring patency), the main diagnostic method becomes the CP, it will allow to determine the degree of stricture and determine the ability and tactics of the operation.

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    Mechanical trauma affecting not only the mucous layer, may be accompanied by rupture of the body. In this case, CT is the only way to see the scale of the disaster.

    Hernia diaphragmatic openings

    It is frequently asymptomatic and becomes finding on CT of the chest. But the hernia is large or disadvantaged will have symptoms and require surgical treatment. They can be seen not only CT, but also ultrasound and x-ray, but to determine the tactics of further treatment the doctor can only in the presence of CT images.

    Conclusion

    The development of private medicine allows you to perform a CT scan without a doctor’s referral. However, before taking such a decision, it is worth remembering that this is accompanied by a high dose of radiation several times greater than the dose received during an x-ray. Many of the symptoms are very nonspecific, so the first thing you should consult a gastroenterologist and may need the results of other studies.

    However, if your doctor has prescribed a CT scan, do not be afraid, when a single load, x-rays will not harm.

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