Key Points

• Plain chest radiographs can provide significant information related to the normal and abnormal esophagus.
• Despite steady decline in requests, barium studies still play a role in the evaluation of the esophagus.
• Using meticulous technique and a tailored approach, the barium esophagogram is essential diagnostic examination in patients with esophageal diseases.
• The barium esophagogram is the single most comprehensive examination in patients with GERD before and after antireflux surgery.
• CT or MRI is essential to identify and characterize disease extrinsic to the esophagus.

In the new millennium, imaging remains an important aspect in evaluating patients with esophageal diseases. Although the barium esophagogram has fallen into disuse in many institutions, supplanted by endoscopy and manometry, we find that it remains an essential tool in evaluating patients with esophageal symptoms, especially dysphagia. In the past, computed tomography (CT) was used for locoregional and distant staging of esophageal carcinoma. It now is used primarily in conjunction with positron emission tomography (PET), providing attenuation correction data for the PET scan as well as an anatomic road map for precise location of hypermeta-bolic activity. Lastly, although magnetic resonance imaging (MRI) is rarely used in assessing patients with esophageal disease, when an enhanced CT is contraindicated MRI with gadolinium enhancement is a very reasonable alternative for staging patients with esophageal carcinoma. The purpose of this chapter is to discuss the radiographic techniques used in assessing patients with esophageal diseases. PET/CT and endoscopic ultrasonography are discussed in other chapters but are referred to when appropriate.