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Usefulness of High-Density Barium for Detection of Leaks After Esophagogastrectomy, Total Gastrectomy, and Total Laryngectomy

Jonathan O. Swanson1, Marc S. Levine, Regina O. Redfern and Stephen E. Rubesin

1 All authors: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.



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  		Fig. 1A. —67-year-old man with leak from esophagogastric anastomosis seen only on image obtained with high-density barium. Spot radiograph from right posterior oblique esophagogram obtained with water-soluble contrast agent shows esophagogastrectomy and gastric pull-through with esophagogastric anastomosis (arrow) just below thoracic inlet. No leak is seen in region of anastomosis.

 


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  		Fig. 1B. —67-year-old man with leak from esophagogastric anastomosis seen only on image obtained with high-density barium. Spot radiograph from repeated right posterior oblique esophagogram obtained with high-density barium shows focal leakage of barium from left lateral aspect of esophagogastric anastomosis (small straight arrows) into 3-cm sealed-off collection (large straight arrows) in mediastinum. Note nasogastric tube (curved arrows) traversing anastomosis.

 


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  		Fig. 2A. —79-year-old man with leak from esophagojejunal anastomosis seen only with high-density barium. Spot radiograph from frontal esophagogram obtained with water-soluble contrast agent shows total gastrectomy and esophagojejunostomy with esophagojejunal anastomosis (white arrow) in lower chest. No leak can be seen, but anastomotic region is not well depicted. Note nasogastric tube (black arrows) traversing anastomosis.

 


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  		Fig. 2B. —79-year-old man with leak from esophagojejunal anastomosis seen only with high-density barium. Spot radiograph from repeated frontal esophagogram obtained with high-density barium shows focal leakage of barium from right lateral aspect of esophagojejunal anastomosis into 1.3-cm sealed-off collection (arrow) in mediastinum.

 


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  		Fig. 3A. —62-year-old man with leak from esophagojejunal anastomosis seen only with high-density barium. Spot radiograph from frontal esophagogram obtained with water-soluble contrast agent shows total gastrectomy and esophagojejunostomy with esophagojejunal anastomosis (arrows) in lower chest. No leak can be seen in region of anastomosis.

 


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  		Fig. 3B. —62-year-old man with leak from esophagojejunal anastomosis seen only with high-density barium. Spot radiograph from repeated frontal esophagogram obtained with high-density barium shows focal leakage of barium from left lateral aspect of esophagojejunal anastomosis into 1-cm blind-ending track (arrow) in mediastinum.

 


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  		Fig. 4A. —70-year-old man with leak from neopharynx seen only with high-density barium. Spot radiograph from lateral esophagogram obtained with water-soluble contrast agent shows total laryngectomy with surgically reconstructed pharynx. No leak can be seen in region of neopharynx. Note drain (arrow) in neck.

 


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  		Fig. 4B. —70-year-old man with leak from neopharynx seen only with high-density barium. Spot radiograph from repeated lateral esophagogram obtained with high-density barium shows focal leakage of barium from anterior aspect of proximal neopharynx into 1.2-cm blind-ending track (arrow) in neck.

 

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