Question

Which dye is used in the diagnosis of esophageal perforation?

• A. Iohexol
• B. Barium sulphate
• C. Gadolinium
• D. Iodine dye

Hint:

Suspected leak means use a water-soluble agent, not barium.

Answer 1

The Correct Option is A

Step 1: When esophageal perforation is suspected, a contrast swallow study is performed to look for extravasation of contrast outside the lumen, which confirms the leak.

Step 2: The contrast must be chosen carefully. Barium, if it leaks into the mediastinum, causes a severe inflammatory mediastinitis. So a water-soluble agent is used first. Iohexol (Omnipaque) is a water-soluble, low-osmolar iodinated contrast that is safe to use when a perforation is suspected, making it the correct choice (option a).

Step 3: The distractors are unsuitable as the initial agent. Barium sulphate (option b) risks mediastinitis if it leaks. Gadolinium (option c) is an MRI contrast, not used for swallow fluoroscopy of perforation. "Iodine dye" (option d) is too non-specific compared with the named water-soluble agent iohexol. Note that small amounts of barium may be used only if no leak is seen on the initial water-soluble study.