The gastric cardia in double-contrast study: its dynamic image.

Difficulties in evaluating the gastric cardia are well known and may often be resolved with the double-contrast technique. Special views to show the cardia en face were obtained in 200 double-contrast examinations. Four basic patterns were recognized. Similar appearances could be reproduced by protruding or retracting the lower end of the esophagus during the radiography of intact stomachs obtained at autopsy. Influenced by muscle relaxants, swallowing, or deep breathing, cardia patterns were found to be interchangeable in the same patient and same examination. The disappearance of the protrusion pattern at the cardia in the course of swallowing is an important means of distinguishing normality from a tumor in this area. Any significant deviation from the normal geometry of the cardia as displayed by double contrast indicates an abnormality. Examples of abnormalities are illustrated.