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Different Patterns of Colonic Tumors Different Patterns of Colonic Tumors in in

Barium Barium StudiesStudies

Different Patterns of Colonic Tumors Different Patterns of Colonic Tumors in in

Barium Barium StudiesStudies

S. RadS. Rad

Selected Cases from the Personal FileSelected Cases from the Personal File

Tabriz Med. Sc. UniversityTabriz Med. Sc. University

S. RadS. Rad

Selected Cases from the Personal FileSelected Cases from the Personal File

Tabriz Med. Sc. UniversityTabriz Med. Sc. University

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According to the appearance of According to the appearance of the tumors in barium studies they the tumors in barium studies they are categorized in different types. are categorized in different types. Followings are some examples Followings are some examples for each type.for each type.

According to the appearance of According to the appearance of the tumors in barium studies they the tumors in barium studies they are categorized in different types. are categorized in different types. Followings are some examples Followings are some examples for each type.for each type.

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Polypoid or Fungating types:Polypoid or Fungating types:

They produce bulky mass invading some part of They produce bulky mass invading some part of the colonic lumen and are demonstrated as the the colonic lumen and are demonstrated as the genuine filling defects.genuine filling defects.

They stand usually in the places where there is They stand usually in the places where there is enough room for them to expand such as enough room for them to expand such as rectum and cœcum.rectum and cœcum.

Polypoid or Fungating types:Polypoid or Fungating types:

They produce bulky mass invading some part of They produce bulky mass invading some part of the colonic lumen and are demonstrated as the the colonic lumen and are demonstrated as the genuine filling defects.genuine filling defects.

They stand usually in the places where there is They stand usually in the places where there is enough room for them to expand such as enough room for them to expand such as rectum and cœcum.rectum and cœcum.

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Filling defect shows the Filling defect shows the intraluminal part of the intraluminal part of the

tumortumor

Tumor mass may not be Tumor mass may not be seen in barium study but in seen in barium study but in

the CT, US or MR scansthe CT, US or MR scans

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Barium studies Barium studies delineate only the delineate only the

intra-luminal intra-luminal component of the component of the tumor and to see tumor and to see

the whole extent of the whole extent of the tumor we have the tumor we have

to implement to implement cross-sectional cross-sectional

imaging.imaging.

Barium studies Barium studies delineate only the delineate only the

intra-luminal intra-luminal component of the component of the tumor and to see tumor and to see

the whole extent of the whole extent of the tumor we have the tumor we have

to implement to implement cross-sectional cross-sectional

imaging.imaging.

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Extraluminal component of the

tumors may be small like

carcinomas or large and bulky

such as in sarcomas or lymphomas.

Extraluminal component of the

tumors may be small like

carcinomas or large and bulky

such as in sarcomas or lymphomas.

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Apr 12, 2023 S. R. 9Polypoid tumor with intussusceptionsPolypoid tumor with intussusceptions

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Fecal impaction in the ascending

colon was noticed in the preliminary

scout film we usually take

before barium enema.

To follow…

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……Fecal impaction ( on the right) did not allowed barium Fecal impaction ( on the right) did not allowed barium filling, so we did barium meal ( on the left) and bulky tumor filling, so we did barium meal ( on the left) and bulky tumor was shown in this film.was shown in this film.

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Barium was expelled and this film was taken after that.

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Metastatic gall-bladder carcinoma in Metastatic gall-bladder carcinoma in the colon.the colon.

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Metastatic urinary bladder carcinoma.Metastatic urinary bladder carcinoma.

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Annular Constricting types:Annular Constricting types:

They show usually the shortest filling defects They show usually the shortest filling defects among colon tumors. Initially they invade among colon tumors. Initially they invade unilaterally the lumen to become annular unilaterally the lumen to become annular around it and produce typical around it and produce typical apple coreapple core pattern.pattern.

Annular Constricting types:Annular Constricting types:

They show usually the shortest filling defects They show usually the shortest filling defects among colon tumors. Initially they invade among colon tumors. Initially they invade unilaterally the lumen to become annular unilaterally the lumen to become annular around it and produce typical around it and produce typical apple coreapple core pattern.pattern.

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Apple core pattern and typical Apple core pattern and typical shoulderingshouldering of the margins of the margins

Apple core pattern and typical Apple core pattern and typical shoulderingshouldering of the margins of the margins

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Dilatation of the proximal Dilatation of the proximal segment after a while.segment after a while.

Dilatation of the proximal Dilatation of the proximal segment after a while.segment after a while.

Apple core Apple core patternpattern

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Acute marginal angles or shouldering sign may disappear proximally because of its dilatation

Acute marginal angles or shouldering sign may disappear proximally because of its dilatation

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Polyp

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Once again double Once again double contrast doesn’t show the contrast doesn’t show the tumor but the meal did it tumor but the meal did it

from the pother wayfrom the pother way

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Infiltrating or scirrhous types:Infiltrating or scirrhous types:

They are having more or less long They are having more or less long segment without clear-cut margins with segment without clear-cut margins with the neighborhood and are very alike the neighborhood and are very alike inflammatory processes and are inflammatory processes and are sometimes hard to discriminate.sometimes hard to discriminate.

Infiltrating or scirrhous types:Infiltrating or scirrhous types:

They are having more or less long They are having more or less long segment without clear-cut margins with segment without clear-cut margins with the neighborhood and are very alike the neighborhood and are very alike inflammatory processes and are inflammatory processes and are sometimes hard to discriminate.sometimes hard to discriminate.

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Ulcerating types:Ulcerating types:

Characteristic Characteristic meniscusmeniscus signsign is the milestone is the milestone for diagnosis of these types and they don’t for diagnosis of these types and they don’t differ from the malignant ulcers in the other differ from the malignant ulcers in the other parts of the gastro-intestinal tract concerning parts of the gastro-intestinal tract concerning the overall configuration.the overall configuration.

Ulcerating types:Ulcerating types:

Characteristic Characteristic meniscusmeniscus signsign is the milestone is the milestone for diagnosis of these types and they don’t for diagnosis of these types and they don’t differ from the malignant ulcers in the other differ from the malignant ulcers in the other parts of the gastro-intestinal tract concerning parts of the gastro-intestinal tract concerning the overall configuration.the overall configuration.

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MeniscusMeniscus

UlcerUlcer

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Mural and submucosal types:Mural and submucosal types:

They appear as the external compression They appear as the external compression effects on the barium column unless they effects on the barium column unless they invade lumen in some way. All sarcomas invade lumen in some way. All sarcomas behave in this manner. behave in this manner.

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Fibrosarcoma of Fibrosarcoma of the hipthe hip

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Lymphatic Lymphatic massmass

Lymphatic Lymphatic massmass

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Tumor itself is Tumor itself is not seennot seen

Tethering caused by Tethering caused by adhesionadhesion

Ragged and smooth contourRagged and smooth contourRagged and smooth contourRagged and smooth contour

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Adhesion of Adhesion of the mass to the mass to the colonic the colonic

wallwall

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Metastatic

Hepatoma Gall-bladder tumor

invading colonGall-bladder tumor

invading colon

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Metastatic Metastatic hepatomahepatomaMetastatic Metastatic hepatomahepatoma

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Metastatic Metastatic breast breast

carcinomacarcinoma

Metastatic Metastatic breast breast

carcinomacarcinoma

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Metastatic breast Metastatic breast carcinomacarcinoma

Metastatic breast Metastatic breast carcinomacarcinoma

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Mixed types:Mixed types:

They share all appropriate characters They share all appropriate characters explained for the unique types and are explained for the unique types and are diagnosed easily because of detailed diagnosed easily because of detailed analytic interpretation. analytic interpretation.

Mixed types:Mixed types:

They share all appropriate characters They share all appropriate characters explained for the unique types and are explained for the unique types and are diagnosed easily because of detailed diagnosed easily because of detailed analytic interpretation. analytic interpretation.

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Ileo-rectostomy following total colectomy

Ileo-rectostomy following total colectomy

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Entero-colostomy after hemicolectomy

Entero-colostomy after hemicolectomy

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For hepatic metastasis we use CT scanning or Ultrasonography and occasionally chest x-ray for rectal tumor in cloacogenic type.

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ConclusionConclusion

Diagnosis of the tumors in the colon is usually Diagnosis of the tumors in the colon is usually straight forward if the fluoroscopy is straight forward if the fluoroscopy is implemented. In fact detection of the tumors is implemented. In fact detection of the tumors is made by searching every corner of the colon made by searching every corner of the colon and spot-films are the first step to register and spot-films are the first step to register them during the examination.them during the examination.

The only difficulty remains in discrimination of The only difficulty remains in discrimination of the infiltrative carcinoma and inflammatory the infiltrative carcinoma and inflammatory processes. This will demand a bit of processes. This will demand a bit of experience of course.experience of course.

ConclusionConclusion

Diagnosis of the tumors in the colon is usually Diagnosis of the tumors in the colon is usually straight forward if the fluoroscopy is straight forward if the fluoroscopy is implemented. In fact detection of the tumors is implemented. In fact detection of the tumors is made by searching every corner of the colon made by searching every corner of the colon and spot-films are the first step to register and spot-films are the first step to register them during the examination.them during the examination.

The only difficulty remains in discrimination of The only difficulty remains in discrimination of the infiltrative carcinoma and inflammatory the infiltrative carcinoma and inflammatory processes. This will demand a bit of processes. This will demand a bit of experience of course.experience of course.

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Thanks for your attentionThanks for your attention