A 60-year-old man presents with sudden severe retrosternal pain after endoscopic oesophageal dilatation. Oesophageal perforation is suspected clinically. Which contrast agent should be used FIRST for the swallow study?

• A Water-soluble iodinated contrast (iohexol) ✓
• B Barium sulphate suspension
• C Air alone as a negative contrast agent
• D Oil-based iodinated contrast (Lipiodol)

Explanation

When perforation of the upper gastrointestinal tract is suspected, a water-soluble iodinated contrast must be used first. Extraluminal barium provokes an intense inflammatory reaction causing mediastinitis or peritonitis and significantly worsens outcome, so it is contraindicated until perforation is excluded. If the water-soluble study shows no leak, barium may follow for better mucosal detail. Oil-based agents are not used for luminal studies and carry a severe aspiration risk.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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