Preliminary Diagnosis: Esophageal Strictures/Webs
I. What imaging technique is first-line for this diagnosis?
PA and lateral view of the chest.
II. Describe the advantages and disadvantages of this technique for diagnosing esophageal strictures/webs.
Advantages
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Highly portable.
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Relatively inexpensive.
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Exposes patients to negligible ionizing radiation.
Disadvantages
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Far less sensitive and specific in detecting a primary abnormality of the esophagus, such as strictures, webs, or any secondary complications, compared to companion contrasted fluoroscopic guided esophagrams and contrasted CT examination.
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Less adept in detailing the surrounding anatomical structures.
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Less useful in guiding or planning treatment.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications to plain radiography exist. However, some institutions may require consent for pregnant patients.
IV. What alternative imaging techniques are available?
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Fluoroscopic guided esophagram.
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CT of the abdomen and pelvis with oral contrast.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing esophageal strictures/webs.
Fluoroscopic guided esophagram
Advantages
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Highly sensitive and specific in detecting a primary esophageal pathological process.
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Highly adept in detecting any secondary complications.
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Offers exquisite detail of the mucosa.
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May help guide treatment.
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The gold standard in evaluating esophageal mucosa and determining the etiology of esophageal strictures and webs.
Disadvantages
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Exposes patients to more ionizing radiation than plain radiography.
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Highly operator dependent.
CT of the abdomen and pelvis with oral contrast
Advantages
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Highly sensitive and specific in detecting any primary esophageal pathological processes and in characterizing any secondary complications.
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Offers exquisite detail of the surrounding anatomical structures.
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Helps guide treatment.
Disadvantages
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CT imaging exposes patients to ionizing radiation.
VI. What are the contraindications for the alternative imaging techniques?
Fluoroscopic guided esophagram
May be contraindicated in pregnant patients.
CT of the abdomen and pelvis with oral contrast
May be contraindicated in pregnant patients.
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