Preliminary Diagnosis: Esophageal Adenocarcinoma

I. What imaging technique is first-line for this diagnosis?

Double contrasted fluoroscopic-guided examination of the esophagus using effervescent crystals and thick liquid barium

II. Describe the advantages and disadvantages of this technique for diagnosis of esophageal adenocarcinoma.

Advantages

  • Highly portable and quick imaging modality

  • May allow for good detail of the esophageal mucosa

    Continue Reading

Disadvantages

  • Highly operator dependent

  • May expose patients to a large amount of ionizing radiation

  • Less sensitive in detailing the surrounding soft tissue, vascular, and osseous structures than other imaging modalities

III. What are the contraindications for the first-line imaging technique?

  • Fluoroscopic imaging may be contraindicated in pregnant patients.

IV. What alternative imaging techniques are available?

  • CT scan of the neck, chest, and abdomen using IV and PO contrast

  • PET/CT scan

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of esophageal adenocarcinoma.

CT scan of the neck, chest, and abdomen using IV and PO contrast
Advantages

  • Offers better sensitivity and specificity in detecting a primary esophageal abnormality and characterizing any secondary complications than other imaging modalities

  • May offer better evaluation of the surrounding soft tissue and osseous structures than other imaging modalities

  • Offers better evaluation of local and distal extension of neoplasm than other imaging modalities

  • Can stage neoplasm

Disadvantages

  • May expose patients to larger amounts of radiation

  • Less portable than other modalities

PET/CT scan
Advantages

  • Offers exquisite correlation of anatomic and functional imaging

  • Extremely adept in detecting subtle local and distal neoplastic disease and helps stage neoplasm

Disadvantages

  • Expensive

  • Requires a long preparation and imaging time

  • Radiopharmaceuticals are contraindicated in pregnant patients or those breastfeeding

VI. What are the contraindications for the alternative imaging techniques?

CT scan of the neck, chest, and abdomen using IV and PO contrast

  • May be contraindicated in pregnant patients

PET/CT scan

  • Contraindicated in pregnant patients and those breastfeeding

Copyright © 2017, 2013 Decision Support in Medicine, LLC. All rights reserved.

No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.

Jump to Section