Today I performed an ultrasound on a dog with a suspected FB after my associate had performed a barium series in the morning. The barium traveled through the GI quite quickly however there was a suspicious retention of some barium with an unusual pattern in the stomach. I think that I had learned in a lecture somewhere that barium can interfere with an ultrasound study so it is not ideal to do ultrasound after a barium series – so I was a little hesitant. Has this been anyone’s experience?
Today I performed an ultrasound on a dog with a suspected FB after my associate had performed a barium series in the morning. The barium traveled through the GI quite quickly however there was a suspicious retention of some barium with an unusual pattern in the stomach. I think that I had learned in a lecture somewhere that barium can interfere with an ultrasound study so it is not ideal to do ultrasound after a barium series – so I was a little hesitant. Has this been anyone’s experience? In this case, it didn’t seem to make a difference at all and the stomach and GI tract were easily seen. A FB did appear to be present in the stomach just proximal to the pylorus and the rest of GI tract was normal. Two corn cobs in the stomach were removed at surgery. So maybe barium is not a problem afterall?
Jacquie
Comments
It is recommended that an
It is recommended that an ultrasound is done prior to barium studies as ultrasound is able to penetrate barium filled masses. However, I am not sure of any studies evaluating this effect and to what effect it will change the other findings of GI tract obstruction.
It is recommended that an
It is recommended that an ultrasound is done prior to barium studies as ultrasound is able to penetrate barium filled masses. However, I am not sure of any studies evaluating this effect and to what effect it will change the other findings of GI tract obstruction.
I totally agree with Remo. I
Btw, this is also the contrast media of choice if you suspect GI leakage.
I totally agree with Remo. I have these problems regularly because referring vets tend to do the barium study and then send them to ultrasound. If somebody wants to perform a radiographic contrast study before the abdominal scan, I recommend taking iodine solution orally (the same as used for pyelography or myelography) since fluids are never a problem for ultrasound
I totally agree with Remo. I
Btw, this is also the contrast media of choice if you suspect GI leakage.
I totally agree with Remo. I have these problems regularly because referring vets tend to do the barium study and then send them to ultrasound. If somebody wants to perform a radiographic contrast study before the abdominal scan, I recommend taking iodine solution orally (the same as used for pyelography or myelography) since fluids are never a problem for ultrasound
Ideally I don’t like them to
Ideally I don’t like them to do barium and luckily now after years of our service and diagnosing fb on US they tend to call us first before barium and the techs love us because they all despise barium and it stays on the shelf. But when reality of barium comes across the probe its not much of an issue if a hard fb like a rock or tennis ball is present. But the main trouble is when you have an obstruction pattern from a fluid absorbing cloth or from focal dysfunctional bowel causing the obstruction as barium will shadow on its own as do of course many FB. So can be confusing but the barium will shadow depending on its dependent position so moving the patient form side to side will help it make a “lava lamp” presentation where an obstructive FB wont move and be its normal wine cork with dilated proximal bowel>>GFB>> empty post obstruction bowel. See our study on this: ECVIM 2009 number 1.
I will see if I can dig up some images on barium on US
Ideally I don’t like them to
Ideally I don’t like them to do barium and luckily now after years of our service and diagnosing fb on US they tend to call us first before barium and the techs love us because they all despise barium and it stays on the shelf. But when reality of barium comes across the probe its not much of an issue if a hard fb like a rock or tennis ball is present. But the main trouble is when you have an obstruction pattern from a fluid absorbing cloth or from focal dysfunctional bowel causing the obstruction as barium will shadow on its own as do of course many FB. So can be confusing but the barium will shadow depending on its dependent position so moving the patient form side to side will help it make a “lava lamp” presentation where an obstructive FB wont move and be its normal wine cork with dilated proximal bowel>>GFB>> empty post obstruction bowel. See our study on this: ECVIM 2009 number 1.
I will see if I can dig up some images on barium on US
You can also pick you
You can also pick you approach based on the latest radiograph. Its key to get the GI bridges to dx obstruction. GES, Pylorus, ICJ, and pelvic colon so You can see the dilation/empty bowel interface. So on this rad I would go right intercostal 11-13 to get the pylorus and would avoid the barium in the gastric fundus.
You can also pick you
You can also pick you approach based on the latest radiograph. Its key to get the GI bridges to dx obstruction. GES, Pylorus, ICJ, and pelvic colon so You can see the dilation/empty bowel interface. So on this rad I would go right intercostal 11-13 to get the pylorus and would avoid the barium in the gastric fundus.
Or in this case I know I can
Or in this case I know I can image the GES, and desc colon free of barium so I know the sono properties that are not related to barium. Therefore 3/4 battles on barium have been resolved and I only have the icj to deal with regarding the barium interference. Honestly most the time its a non factor because it will be part of the fluid dilation prior to the obstruction. If you have dilated small bowel in the presence of empty small bowel and you have images a normal pylorus, icj and you know what the stool in the colon looks like, there is an obstruction from fb, tumor, or dysfunctional local bowel.
Or in this case I know I can
Or in this case I know I can image the GES, and desc colon free of barium so I know the sono properties that are not related to barium. Therefore 3/4 battles on barium have been resolved and I only have the icj to deal with regarding the barium interference. Honestly most the time its a non factor because it will be part of the fluid dilation prior to the obstruction. If you have dilated small bowel in the presence of empty small bowel and you have images a normal pylorus, icj and you know what the stool in the colon looks like, there is an obstruction from fb, tumor, or dysfunctional local bowel.
Thanks Remo, Peter and Eric –
Thanks Remo, Peter and Eric – I was afraid that I might miss something or over-diagnose a FB in this case due to the barium, but luckily the u/s findings were consistent with what was found at surgery. Will need to train my associates to think of ultrasound first, then barium second (unfortunately I was out of the office that morning!)
I have tried to look up references on barium and veterinary ultrasonography but have found none. I found some human studies with some conflicting opinions and looking at different aspects.
Jacquie
Thanks Remo, Peter and Eric –
Thanks Remo, Peter and Eric – I was afraid that I might miss something or over-diagnose a FB in this case due to the barium, but luckily the u/s findings were consistent with what was found at surgery. Will need to train my associates to think of ultrasound first, then barium second (unfortunately I was out of the office that morning!)
I have tried to look up references on barium and veterinary ultrasonography but have found none. I found some human studies with some conflicting opinions and looking at different aspects.
Jacquie
This is a linear fb and
This is a linear fb and intussusception that was at the end of another barium case and was found on the technique described above.
This is a linear fb and
This is a linear fb and intussusception that was at the end of another barium case and was found on the technique described above.
Above in my first post I have
Above in my first post I have inserted a pic of the barium soaked corn cob in the stomach – I suspect that some of the strong shadowing is from the barium on the FB. This was about 4 hr post barium.
Above in my first post I have
Above in my first post I have inserted a pic of the barium soaked corn cob in the stomach – I suspect that some of the strong shadowing is from the barium on the FB. This was about 4 hr post barium.