CT esophagography

Last revised by Dr Mohamed Saber on 29 Apr 2021

CT esophagography is a CT study designed to primarily evaluate the esophagus, particularly in the situation of esophageal trauma and potential perforation. It has been developed partly as an alternative to fluoroscopic barium swallow evaluation in this situation.

The are multiple potential ways to perform a CT esophagram, with the key variables:

  • type of oral contrast to give
    • it is not clear whether diatrizoate meglumine (Gastrografin) or a solution of iodinated  CT contrast agent (e.g. Omnipaque) is better; if the patient is an aspiration risk, then avoiding Gastrografin seems prudent
    • protocols do not include the use of barium
  • how much oral contrast to give
    • both diluted and undiluted contrast formulations have been used in protocols without a clear consensus
  • how quickly to begin scanning
  • whether to administer IV contrast

One such protocol 1:

  • scan field of view from the angle of the mandible to the level of the iliac crests
  • a non contrast series is obtained
  • the patient then drinks half a cup (~4 oz) of water soluble contrast agent
  • this is then followed with the patient drinking the other half of the cup in a supine position (with a straw)
  • after a 5 second delay, the post swallow series is obtained
  • could be repeated in the prone position if an anterior leak is suspected on the non contrast series
  • allergy to the oral contrast agent
  • an obtunded/comatose patient, since the patient cannot protect his or her airway
    • in select situations, a nasogastric tube could be advanced and enteric contrast administered through it before scanning

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Cases and figures

  • Case 1: perforation of pharyngeal pouch
    Drag here to reorder.
  • Case 2: iatrogenic esophageal perforation with pleural fistula
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