In water-soluble contrast swallow, leakage of contrast from the esophagus following esophagectomy is best evaluated using:

• A Barium sulfate suspension
• B Non-ionic iso-osmolar water-soluble contrast (e.g., iohexol) ✓
• C Gastrografin (ionic water-soluble contrast)
• D CT with oral contrast alone

Explanation

Non-ionic iso-osmolar water-soluble contrast agents (such as iohexol) are preferred for evaluating anastomotic leak after esophagectomy because they are safe if aspirated (unlike barium, which causes granulomatous reaction) and do not cause the severe pulmonary edema that ionic hyperosmolar agents (Gastrografin) can cause if aspirated. Gastrografin is contraindicated when aspiration risk is high. CT with oral contrast can diagnose leaks but cannot directly visualize contrast extravasation at the anastomosis as well as a fluoroscopic swallow.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.