Radiology Notes

My notes during radiology residency, fellowship, and beyond…

Archive for the ‘esophagus’ Category

Esophageal Perforation

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  • 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

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    • 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

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    • 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

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    • 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

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    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

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    • 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

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    • 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

    Peptic and Inflammatory Esophagitis

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    • mild reflux – thickened folds only
    • mod reflux – thickened folds and tiny ulcers
    • severe reflux – folds and moderate to large ulcers
    • chronic reflux – stricture above GEJ, scarring deformity, transverse folds
    • Barrett esophagus – stricture at high location, transition zone, reticulated mucosal pattern
    • Medication-induced – ulcer with edema, level or arch or distal
    • Crohn esophagitis – aphthous ulcers, confluent

    Written by lmwong

    September 25, 2008 at 1:34 am

    Multiple Esophageal Mucosal Masses

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    Nonneoplastic

    • Candida Esophagitis
    • Reflux Esophagitis
    • Glycogenic Acanthosis
    • Crohn’s Disease
    • Pemphigoid and Epidermolysis Bullosa
    • Hairy Esophagus

    Neoplastic

    • Papillomatosis
    • Superficial Spreading Carcinoma
    • Cowden’s Syndrome
    • Leukoplakia

    Written by lmwong

    April 9, 2008 at 4:32 pm

    Intussusception in Adults

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    • LIPOMA
    • malignant tumor
    • Meckel diverticulum
    • Lymphoma
    • Mesenteric nodes
    • Foreign body

    Written by lmwong

    April 9, 2008 at 4:31 pm

    Video Esophagram Dictation

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    Indication: [x]

    Technique: Standard video esophagram.

    Comparison: [x]

    Findings:
    The patient was given thin and thick barium liquid, applesauce mixed with barium paste and crackers mixed with barium.
    The oral and pharyngeal phases of swallowing are normal. No nasal regurgitation, laryngeal penetration or aspiration is identified. No pharyngeal morphologic abnormalily is visualized.

    Esophageal motility is grossly within normal limits. No gastroesophageal reflux is identified, despite the performance of maneuvers to ellicit GE reflux. No gross morphologic esophageal abnormality is detected.

    Impression: Unremarkable videoesophagram.

    Written by lmwong

    April 7, 2008 at 8:50 pm

    Double Contrast Esophagram Dictation

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    Indication: [x]

    Technique: A standard air contrast esophagram was performed.

    Comparison: [x]

    Findings:
    The patient swallowed barium without difficulty. The oral and pharyngeal phases of swallowing are normal. There is no nasal regurgitation, laryngeal penetration or aspiration identified. Esophageal motility is within the limits of normal.
    The esophagus is structurally normal without intrinsic or extrinsic masses. The esophageal mucosa appears normal. No gastroesophageal reflux was demonstrated during this examination, despite the performance of maneuvers to elicit GE reflux.

    Impression: Unremarkable esophagram.

    Written by lmwong

    April 7, 2008 at 8:48 pm

    Esophageal Carcinoma

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    • most common risk factor is smoking and ETOH
    • presents with chest pain or progressive dysphagia
    • Squamous < Adenocarcinoma (Barrett’s)
    • Gastric invasion and distal location suggest adenocarcinoma
    • most common benign tumor = leiomyoma
    • tracheoesophageal stripe >5 mm
    UGI Findings
    • irregular contour
    • abrupt shouldering edges
    • central ulcer that does not project beyond mucosa
    • polypoid or varicoid appearance = Adenocarcinoma

    Written by lmwong

    April 7, 2008 at 3:19 am

    Posted in cancer, esophagus, tumor

    Esophageal Masses

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    • Pharyngeal carcinoma: proximal
    • Lymphoma = resembles primary neoplasm; polypoid, ulcerative, infiltrating
    • Adenoma = distal, forms within Barrett; malignant degeneration can occur
    • Esophageal carcinoma: SSC > adenocarcinoma: irregular thickening, eccentric narrowing, dilation above,¬†shouldered margins; pseudoachalasia
    • Esophageal Lymphoma
    • Gastric adenoacarcinomas (that extends up)
    • Leiomyoma (GIST)
    • Inflammatory esophagogastric polyp (enlarged gastric fold projecting into lower esophagus; no malignant potential; from reflux; recommend endoscopy)
    • Fibrovascular Polyp = large intraluminal fat-filled mass with stalk; dilated esophagus; B9; frequently in cervical esophagus; LONG 7-20cm; can regurgitate polyp)
    • Esophageal duplication cysts
    • Extrinsic lesions
    • Spindle Cell Carcinoma = carcinoma + sarcoma; bulky, polypoid, intraluminal; pedicle attaches it to esophagus.

    Written by lmwong

    April 7, 2008 at 3:16 am

    Esophageal Varices

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    Uphill

    • cause bleeding
    • from portal HTN (reversal of flow “uphill” from portal vein > left gastric > periesophageal venous plexus > azygous and hemiazygous collaterals > SVC)
    • collapsing, long serpentine filling defects in the distal esophagus on UGI study; differentiate from varicoid carcinoma
    Downhill
    • asymptomatic
    • obstruction of SVC > collateral enlargement in supreme intercostal, bronchial and inferior thyroid veins
    • tubular thickened folds in upper thoracic esophgus
    • look for reason for SVC syndrome (bronchogenic carcinoma, lymphoma, or fibrosing mediastinitis)

    Written by lmwong

    April 7, 2008 at 3:12 am

    Posted in esophagus, varices

    Esophageal Strictures

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    • Esophagitis: Reflux, Barrett, Corrisive, Radiation
    • Neoplasm: SCC, adenocarcinoma, mets, lymphoma
    • Webs
    • Extrinsic
    • Infection: TB, candida, syphilis
    • Achalasia
    • Pemphigoid, epidermolysis bullosa

    Written by lmwong

    April 5, 2008 at 6:53 pm

    Esophageal Outpouchings

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    • Lateral pharyngeal diverticula
    • Zenker Diverticulum; through Killian dehiscence = posterior
    • Killian-Jamieson diverticulum = anterior
    • Midesophageal diverticula (pulsion > traction)
    • Epiphrenic diverticula (pulsion)
    • Sacculations
    • Intramural pseudodiverticula = multiple and tiny
    Pulsion = pressure; fusiform –> most common today, from motor disorders
    Traction = tugging; jagged, extrinsic –> TB

    Written by lmwong

    April 5, 2008 at 4:10 am