Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘esophagus’ Category

Esophageal Perforation

leave a comment »

  • most commonly by iaotragenic causes (75% endoscopy)
  • most involve cervical esophagus, cricopharyngeaus muscle
  • untreated, 70% mortality
  • chest XR: pneumomediastinum, widened mediastinum, hydropneumothorax, pleural effusion, subcutaneous emphysema
  • confirm with gastrograffin esophogram = water soluble materal
  • CT good for further evaluation, finding location of leak

    Written by lmwong

    January 6, 2010 at 9:24 am

    Posted in chest, esophagus, gi

    Achalasia

    leave a comment »

    • dysphagia, regurgitation, aspiration PNA
    • aperistalsis of the distal 2/3 and failure of the LES to relax
    • single contrast UGI = bird-beak narrowing and column of contrast opacifying dilated esophagus.
    • recommend Manometry
    • Rx: balloon dilatation and Heller myotomy (surgical incision)
    • DDx: Chagas disease, pseudoachalasia (carcinoma of the GE junction)
    • Eventual LES relaxation with continued drinking, distinguishes this from pseduoachalasia
    • Complications: Candida from stasis and Carcioma in upper/mid esophagus (20 years).

    Written by lmwong

    December 19, 2009 at 2:21 am

    Posted in esophagus, gi

    Diffuse Esophageal Spasm

    with 2 comments

    • dysphagia and chest pain
    • nonpropulsive contraction
    • impaired LES relazation
    • increased resting pressures
    • corkscrew, curling, rosary bead, shish kabob
    • nutcracker esophagus
    • >180 mm Hg on manometry

    Written by lmwong

    December 17, 2009 at 4:24 am

    Posted in esophagus, gi

    Feline esophagus

    leave a comment »

    • multiple thin transverse folds
    • transient (distinguish from chronic reflux esophagitis)
    • cross entire esophageal lumen
    • normal varient

    Written by lmwong

    December 17, 2009 at 3:28 am

    Posted in esophagus, gi

    Esophageal Filling Defects

    leave a comment »

    Benign

    • GIST
    • Adenoma
    • Inflammatory polyp
    • Fibrovascular polyp

    Malignant

    • carcinoma
    • mets
    • lymphoma
    • spindle cell carcinoma
    • malignant GIST

    Nonneoplastic

    • varices
    • duplication cyst
    • ectopic gastric mucosa
    • foreign body

    Written by lmwong

    December 17, 2009 at 3:14 am

    Posted in differential, esophagus, gi

    Esophageal duplication cyst

    leave a comment »

    • type of foregut cyst
    • lined with squamous epithelium, smooth muscle wall
    • mass effect
    • anywhere in posterior mediastinum
    • CT shows liquid vs solid (GIST)

    Written by lmwong

    December 17, 2009 at 3:07 am

    Posted in chest, esophagus, gi, mediastinal

    Infectious Esophagitis

    leave a comment »

    • Candidiasis – plaquelike, shaggy
    • Herpes – multiple discrete ulcers
    • CMV – large, flat, solitary ulcer
    • HIV – indistinguishable from CMV

    Written by lmwong

    September 25, 2008 at 1:39 am