Radiological Anatomy of
the Upper Gastrointestinal Tract
Dr. Yasir Al Sheikh
Consultant Radiologist
Radiology & Medical Imaging Department
King Khalid University Hospital
2014
Esophageal Anatomy
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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 Anatomy
Esophageal 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 Veins
• 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”)
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)
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Swallow Indications:
Dysphagia
Pain
Tracheo-esophageal Fistula
Esophageal perforation
Pre-operative assessment of bronchial Ca
Esophageal Anatomy
Esophageal Constrictions
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 Peristalsis
Normal:
Primary contraction:
Propels bolus through the esophagus
Secondary contraction:
Follows primary contraction and propels
any remaining bolus from thoracic esophagus
Esophageal Anatomy
Esophageal Peristalsis
Abnormal:
Tertiary contractions.(A)
presbyesophagus: Nonpropulsive contractions
Diffuse esophageal spasm**
Nutcracker esophagus
Decreased peristalsis resulting from achalasia, scleroderma,
dermatomyositis, polymyositis, esophagitis, …….
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esophagus
Stomach Anatomy
Lower
esophageal
sphincter
stomach
lesser
curvature
rugae
Pyloric sphincter
 Regions of stomach:
antrum
• Cardiac
greater curvature
duodenum
• Fundus
• Corpus
• Pyloric: antrum, canal, sphincter
 Lesser & greater omental
 Winslow’s foramen: communication of lesser & greater sacs
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
Radiology Stomach Anatomy
Imaging Modalities
Fluoroscopy (Barium Swallow, Upper GI)
CT
Exam may be performed
Single-contrast
Double-contrast
Radiology Stomach Anatomy
esophagus
Lower
esophageal
sphincter
stomach
Pyloric sphincter
lesser
curvature
rugae
antrum
duodenum
greater curvature
Radiology Stomach Anatomy
Imaging Modalities
COMPUTED TOMOGRAPHY
Radiology Stomach Anatomy
Imaging Modalities
COMPUTED TOMOGRAPHY