Radiological Anatomy of Radiological Anatomy of the Upper Gastrointestinal the Upper Gastrointestinal TractTract

Consultant RadiologistRadiology & Medical Imaging Department

King Khalid University Hospital2014

Dr. Yasir Al SheikhDr. Yasir Al Sheikh

Esophageal Anatomy

• Fibromuscular tube about 10” (25 cm) long: C6–T10

• Variation in length according to age. (Pedia:C5-T9)

• Flat in upper 2/3 & rounded in lower 1/3

• Esophageal plexus (vagus + sympathetics)

• Vagal trunks (anterior & posterior)

• Esophageal hiatus in diaphragm

• Right crus of diaphragm forms a sphincter-like sling

Esophageal Anatomy

Esophageal Constrictions

• Superiorly: level of cricoid cartilage, juncture with pharynx• Middle: crossed by aorta and left main bronchus• Inferiorly: diaphragmatic sphincter

Esophageal AnatomyEsophageal Arteries

• Upper esophageal sphincter and cervical esophagus: inferior thyroid artery • Thoracic esophagus: terminal branches of bronchial arteries • Lower esophageal sphincter and distal esophagus: left gastric artery and a branch of the left phrenic artery

• Esophageal vv. drain into SVC via azygous & hemiazygous v. • Esophageal vv. drain into portal v. via branches of left gastric v. (a “portal- caval anastomosis”)

Esophageal Veins

Radiology of Esophageal Anatomy

Imaging Modalities

Fluoroscopy (Barium Swallow, Upper GI)CT 

Radiology of Esophageal Anatomy

Imaging Modalities

Fluoroscopy (Barium Swallow, Upper GI)

•This is dynamic study which allow visualization of outline and movement (peristalsis)•Examination may be performed using single-contrast or double-contrast. •Patients are asked to be NPO 8 hours prior to examination.

Radiology of Esophageal Anatomy

Imaging Modalities

Fluoroscopy (Barium Swallow, Upper GI)

Ba Swallow Indications:•Dysphagia•Pain•Tracheo-esophageal Fistula •Esophageal perforation •Pre-operative assessment of bronchial Ca

This oblique view of a normal barium swallow shows the normal impressions made by

(A) aortic arch. (B) left mainstem bronchus. (LA) left atrium on the esophagus

Esophageal Anatomy

Esophageal Constrictions

Esophageal Anatomy

Esophageal Peristalsis

Normal:Primary contraction: Propels bolus through the esophagusSecondary contraction: Follows primary contraction and propelsany remaining bolus from thoracic esophagus

Esophageal Anatomy

Esophageal Peristalsis

Abnormal:Tertiary contractions.(A) presbyesophagus: Nonpropulsive contractionsDiffuse esophageal spasm**Nutcracker esophagusDecreased peristalsis resulting from achalasia, scleroderma, dermatomyositis, polymyositis, esophagitis, …….

**

Stomach Anatomy

Regions of stomach: • Cardiac • Fundus • Corpus• Pyloric: antrum, canal, sphincter Lesser & greater omental Winslow’s foramen: communication of lesser & greater sacs

stomach

esophagus

greater curvature

lesser curvature

Pyloric sphincter

duodenum

Lower esophageal

sphincter

Rugae are mucosal folds seen in the nondistended stomach. The areae gastricae represent the normal reticular mucosal pattern of the stomach, most prominent in the body and antrum. The lesser curvature forms the right gastric border and extends from the cardia to the pylorus

rugae

antrum

Radiology Stomach Anatomy

Imaging Modalities

Fluoroscopy (Barium Swallow, Upper GI)CT 

Exam may be performed Single-contrast Double-contrast

Radiology Stomach Anatomy

stomach

esophagus

greater curvature

lesser curvature

Pyloric sphincter

duodenum

Lower esophageal

sphincter

rugae

antrum

Radiology Stomach Anatomy

Imaging Modalities

COMPUTED TOMOGRAPHY 

Radiology Stomach Anatomy

Imaging Modalities

COMPUTED TOMOGRAPHY