What is a filling defect in the body of the stomach? Gastroenterology. The radiographic symptom of a “niche” is observed when

A local decrease or complete disappearance of the shadow in a limited area of ​​the silhouette of a contrasted organ is a symptom “ filling defect" The pathomorphological basis of this symptom complex is an additional formation that protrudes into the lumen of the cavitary organ and, accordingly, narrows or completely closes this cavity.

As a result, the cavity occupied by additional education, cannot be completely filled with a contrasting mass, and its shadow appears as if with a flaw (i.e., with a shadow defect), enlightenment in place of the formation existing inside. The filling defect is “plus fabric - minus shadow” (the opposite of the niche symptom, where “plus shadow - minus fabric”). The filling defect is most often of a tumor nature, but it can also be caused by stones in the lumen of the organ (gallbladder), fecal stones in the intestines, roundworm balls, foreign bodies and other formations of a volumetric nature.
X-ray symptom " filling defect“is determined by areas of clearing in the general shadow of the contrasted organ, if the defect occupies a middle, central position.

If the filling defect occupies an edge position, along the contour of the shadow, it will be revealed in the form of an edge defect, the absence of a shadow in this area. If the filling defect is located in the distal parts of the organ under study, that part of the contrasted cavity will be determined where the lumen is preserved, and where the filling defect will be the absence of a shadow, the organ will have a shape as if with a resected (amputated) distal part.

An X-ray of the stomach is performed with contrast enhancement. For these purposes, a person takes half a glass of barium sulfate solution (the dosage varies depending on the purposes of the study). A provocative test is first carried out to exclude allergic reactions to this water-insoluble contrast.

If no skin rashes or other changes in the patient’s body are observed within 15 minutes, proceed to fluoroscopy. In case of allergies, the test is not performed.

To identify pathology in the stomach, there are certain pathological syndromes. When interpreting the radiographs, the radiologist describes them and forms an analytical conclusion based on a comparison of the detected pathological signs.

What can be determined on an x-ray of the stomach

A number of x-ray symptoms can be identified on an x-ray of the stomach:

1. Serpa.
2. Syringe.
3. Flows.
4. Filling defect.
5. Kloiber bowls.

When using the double contrast technique (barium and air), it is possible to assess the state of the relief of the mucous membrane of the esophagus and stomach. Normally, the wall of these organs consists of protrusions and concavities. In the esophagus they are directed longitudinally from top to bottom, and in the stomach they have a tortuous course. In the presence of inflammatory diseases, cancer, ulcerative defects, the furrows change direction, decrease or increase (with Ménétrier's disease).

On a conventional contrast radiograph, a change in the relief of the mucous membrane is not detected, since folds are not visible against the background of barium. Studying with air allows you to evenly distribute contrast particles in the grooves, which allows you to clearly trace their contours.

With pathological changes, additional shadows (accumulation of contrast) and clearing also appear.

An X-ray of the stomach is informative if you master gastrography tactics and use several examination methods simultaneously. Its quality significantly depends on the qualifications of the radiologist.

What does the “sickle” symptom on a gastrogram indicate?

The “sickle” symptom on the gastrogram appears when air accumulates in the upper part of the abdominal cavity. The cause of the pathology is a rupture of the intestinal wall with the release of free air during intestinal obstruction, ulcerative defects and necrotizing colitis (inflammation of the intestine with death of the epithelium).

Positioning the patient for abdominal radiography in lateral projection

How to identify the “sickle” symptom in an image:

• a strip of clearing under the right dome of the diaphragm with the patient in an upright position;
• clear upper contour of the liver;
• absence of additional shadows against the background of enlightenment

This symptom requires differential diagnosis with the introduction of the colon between the diaphragm and the liver (interpositio colli). This is quite easy to do. It is necessary to trace the presence or absence of folds formed by intestinal constrictions on an x-ray under the diaphragm.

Identification of a “sickle” in an image requires immediate surgical treatment to save a person’s life. Otherwise, peritonitis (inflammation of the peritoneum) will develop and the person will die from painful shock.

X-ray symptom of “Kloiber cup”

“Kloiber cups” appear on the gastrogram in the presence of intestinal obstruction (mechanical or spastic). At the interface between the intestinal contents and air, darkening with a horizontal level can be traced, which are clearly visible on the x-ray.

How to identify “Kloiber cups” in an image:

• rounded clearing in the projection of the intestine;
• liquid level with a width greater than the gas bubble (in the large intestine);
• detection of “bowls” or “arches” (2 types of X-ray symptoms of intestinal obstruction).

When the amount of air content in the intestines changes, the cups can turn into arches and vice versa.

What does a “filling defect” mean on a stomach image?

A “filling defect” in an image of the stomach means partial disappearance of the anatomical contour of the organ wall due to the growth of a pathological formation. Radiologists call this the “minus shadow plus tissue” symptom. The defect is formed due to the presence of additional tissue, which disrupts the normal x-ray anatomy of the organ structure.

How to detect a filling defect on a gastrogram:

• lack of physiological contour of the stomach wall;
• atypical relief of the mucous membrane;
• uneven, unclear, jagged contours.

By the location of the “filling defect” one can distinguish a benign tumor from a malignant one. With the central location of the “plus tissue” and a slight change in the relief of the folds of the stomach, one can assume the benign nature of the formation.

In malignant tumors, a “filling defect” can reveal a “niche” symptom when organ tissue is destroyed. A “niche” for cancer is different from an ulcerative defect. It is wide, but not deep. A series of gastrographs show an increase in the crater mainly in width.

What does the “niche” symptom show?

This symptom indicates destructive cancer or peptic ulcer. The ulcerative defect has a smooth, clear contour. Its width significantly exceeds the depth of the shadow. Sometimes radiologists describe this symptom as “a niche in the filling defect.” This description indicates that an infiltrative shaft has been formed around the ulcer, which leads to the appearance of “plus tissue” on the radiograph. It is not large in shape and shrinks over time.

A benign ulcer is localized on the lesser curvature of the stomach, and on the opposite side a spastic contraction of the greater curvature is detected.

How to detect cancer “niches” in an image (symptoms of “syringe” and “wraparound”):

• are localized in the stomach most often along the greater curvature;
• lead to deformation of the fundus or esophagus;
• the symptom of “syringe” and “flow around” is concentric compression of the stomach by a tumor with a decrease in its size on an x-ray.

How to identify an ulcer on a stomach image

The main radiological manifestation of an ulcer in the image is the “niche” symptom. It is a crater, the length of which is perpendicular to the wall of the organ.

With contrast gastrography, barium fills the “niche”, so it is clearly visible on the lateral image. On the anterior gastrogram the symptom can be traced in the form of an even round spot.

How to identify ulcers in a stomach image:

• oval and clear contours;
• swelling of the folds of the mucous membrane (“filling defect”);
• narrow and deep “niche”;
• infiltrative shaft due to inflammatory or sclerotic changes in the mucous membrane;
• the “pointing finger” symptom is an indentation on the opposite contour of the stomach due to muscle spasm.

How to detect early stage cancer on a stomach x-ray

The increasing number of patients with stomach cancer requires doctors to detect malignant tumors in the early stages. When detecting tumors of the gastrointestinal tract, contrast radiographic studies play a leading role.

How to detect early stage cancer:

1. Do not forget about studying the relief, since many tumors begin to grow in the submucosal layer.
2. The absence of organ folding on an x-ray may be a sign of a malignant neoplasm. To detect pathology, double contrast is necessary.
3. An increase in the distance between the diaphragm and the gas bubble can occur not only with the “sickle” symptom, but also with cancer of the subcardial part of the stomach.
4. Carefully examine the gas bubble of the stomach in the image. Its shape changes when the organ is bent, which is often found in tumors of the cardiac region.
5. An inflection (the “waterfall” symptom) often occurs with cancerous ulceration of the greater curvature.

To detect the above-described x-ray symptoms, it is important to conduct a polypositional examination of the patient and use different techniques for this. In the horizontal, vertical and lateral position of a person on the X-ray table, during fluoroscopy of the gastrointestinal tract it is necessary to take pictures. They will help identify additional signs of pathology that the doctor did not notice during X-ray examination.

For patients, we remind you that the effectiveness of diagnosing gastrointestinal pathology significantly depends on the quality of intestinal cleansing at the stage of preparation for the study. Follow the radiologist's recommendations carefully!

defect in the X-ray shadow of a contrasted hollow organ; X-ray symptom of the presence of a tumor or foreign body in the cavity.

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"Filling defect" in books

Henri de Regnier

Henri de Regnier Henri de Regnier lives in an ancient castle in Italy, among the emblems and drawings that decorate its walls. He indulges in his dreams, moving from hall to hall. In the evening he descends marble steps into a park paved with stone slabs. There, among the pools and

Henri Barbusse*

Henri Barbusse* From personal memoriesI It was in Moscow. After our victory. Lenin was already chairman of the Council of People's Commissars. I was with him on some business. Having finished the matter, Lenin told me: “Anatoly Vasilyevich, I once again re-read Barbusse’s “Fire”. They say he wrote a new novel

A. BARBUS FROM A LETTER TO THE EDITOR “IZVESTIA OF THE USSR Central Executive Committee”