Preliminary Diagnosis: Esophageal Dysmotility
I. What imaging technique is first-line for this diagnosis?
Single contrast barium esophagram
II. Describe the advantages and disadvantages of this technique for diagnosing esophageal dysmotility.
Advantages
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Single contrast esophagram can accurately depict characteristic appearance of an esophageal diverticulum.
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Air distention (which can cause patient discomfort) is not necessary.
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The examination is relatively inexpensive.
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No significant complications typify this outpatient procedure.
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Barium is a relatively inert compound, and minor aspiration events are typically uneventful.
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This is usually the only imaging study required.
Disadvantages
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Unable to adequately assess mucosal detail in the assessment of esophagitis
III. What are the contraindications for the first-line imaging technique?
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Relative contraindication in pregnancy
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Contraindicated in gastrointestinal perforation (water soluble contrast agents can be used)
IV. What alternative imaging techniques are available?
Tc-99 esophageal transit scintigraphy
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing esophageal dysmotility.
Advantages
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Noninvasive
Disadvantages
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Not routinely performed when conventional esophagography is available
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Use of radioactive pharmaceuticals
VI. What are the contraindications for the alternative imaging techniques?
No absolute contraindications exist.
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