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The spectrum of benign esophageal lesions: imaging findings.

Jang KM, Lee KS, Lee SJ, Kim EA, Kim TS, Han D, Shim YM - Korean J Radiol (2002 Jul-Sep)

Bottom Line: Barium studies are useful for the evaluation of mucosal surface lesions but provide little information about the extramucosal extent of disease.Computed tomography and magnetic resonance imaging, on the other hand, permit the assessment of wall thickness, mediastinal involvement, adjacent lymphadenopathy, and distant spread.In diseases such as fibrovascular polyps, duplication cysts, scleroderma, trauma, caustic esophagitis, hiatal hernia, esophageal diverticulum, achalasia, and paraesophageal varices, the findings of imaging studies are specific, obviating the need for further invasive diagnostic work-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT
Benign esophageal lesions occur in various diseases. Barium studies are useful for the evaluation of mucosal surface lesions but provide little information about the extramucosal extent of disease. Computed tomography and magnetic resonance imaging, on the other hand, permit the assessment of wall thickness, mediastinal involvement, adjacent lymphadenopathy, and distant spread. In diseases such as fibrovascular polyps, duplication cysts, scleroderma, trauma, caustic esophagitis, hiatal hernia, esophageal diverticulum, achalasia, and paraesophageal varices, the findings of imaging studies are specific, obviating the need for further invasive diagnostic work-up. The advent of helical computed tomography and its volume data set allows the acquisition of multiplanar images, and magnetic resonance imaging is useful both for this and for tissue characterization. Thus, multiplanar cross-sectional imaging further extends the role of imaging modalities to the evaluation of benign esophageal lesions. Through an awareness of the multiplanar cross-sectional appearances of various benign esophageal lesions, the radiologist can play an important role in the detection, diagnosis, further diagnostic planning, and treatment of the diseases in which they occur.

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Spontaneous esophageal rupture in a 58-year-old man after heavy alcohol consumption.A. Esophagogram shows no evidence of contrast medium leakage, though mediastinal widening (arrows) is apparent. A nasogastric tube (arrowheads) was inserted.B. Mediastinal window of enhanced (7-mm collimation) CT scan obtained at the level of the aortic arch demonstrates widening of the right superior mediastinum (arrows), and extraluminal air. Also note that parenchymal consolidation (open arrows), probably due to passive atelectasis associated with mediastinal widening, has occurred in the right upper lobe.
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Figure 11: Spontaneous esophageal rupture in a 58-year-old man after heavy alcohol consumption.A. Esophagogram shows no evidence of contrast medium leakage, though mediastinal widening (arrows) is apparent. A nasogastric tube (arrowheads) was inserted.B. Mediastinal window of enhanced (7-mm collimation) CT scan obtained at the level of the aortic arch demonstrates widening of the right superior mediastinum (arrows), and extraluminal air. Also note that parenchymal consolidation (open arrows), probably due to passive atelectasis associated with mediastinal widening, has occurred in the right upper lobe.

Mentions: Perforation is the most serious and life-threatening event to affect the esophagus : in patients with untreated thoracic esophageal perforations, the fulminant mediastinitis which occurs leads to a mortality rate of almost 100%. Endoscopic procedures are responsible for up to 75% of all esophageal perforations (23), which may also be caused by foreign bodies or penetrating trauma. Most perforation involves the cervical esophagus ; spontaneous esophageal perforation (Boerhaave syndrome) due to a sudden, rapid increase in intraluminal esophageal pressure causes full thickness perforation of normal underlying esophageal tissue, and is frequently a result of violent retching or vomiting, usually after an alcoholic binge. Patients with negative esophagograms in whom esophageal perforation is still suspected on clinical grounds may undergo CT ; in such cases, findings of extraluminal gas in the mediastinum are highly suggestive of esophageal perforation (Fig. 11). Where this has occurred, CT is also useful for determining the extent of extraluminal gas and fluid in the mediastinum and for monitoring patients who are treated nonsurgically (24).


The spectrum of benign esophageal lesions: imaging findings.

Jang KM, Lee KS, Lee SJ, Kim EA, Kim TS, Han D, Shim YM - Korean J Radiol (2002 Jul-Sep)

Spontaneous esophageal rupture in a 58-year-old man after heavy alcohol consumption.A. Esophagogram shows no evidence of contrast medium leakage, though mediastinal widening (arrows) is apparent. A nasogastric tube (arrowheads) was inserted.B. Mediastinal window of enhanced (7-mm collimation) CT scan obtained at the level of the aortic arch demonstrates widening of the right superior mediastinum (arrows), and extraluminal air. Also note that parenchymal consolidation (open arrows), probably due to passive atelectasis associated with mediastinal widening, has occurred in the right upper lobe.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2713885&req=5

Figure 11: Spontaneous esophageal rupture in a 58-year-old man after heavy alcohol consumption.A. Esophagogram shows no evidence of contrast medium leakage, though mediastinal widening (arrows) is apparent. A nasogastric tube (arrowheads) was inserted.B. Mediastinal window of enhanced (7-mm collimation) CT scan obtained at the level of the aortic arch demonstrates widening of the right superior mediastinum (arrows), and extraluminal air. Also note that parenchymal consolidation (open arrows), probably due to passive atelectasis associated with mediastinal widening, has occurred in the right upper lobe.
Mentions: Perforation is the most serious and life-threatening event to affect the esophagus : in patients with untreated thoracic esophageal perforations, the fulminant mediastinitis which occurs leads to a mortality rate of almost 100%. Endoscopic procedures are responsible for up to 75% of all esophageal perforations (23), which may also be caused by foreign bodies or penetrating trauma. Most perforation involves the cervical esophagus ; spontaneous esophageal perforation (Boerhaave syndrome) due to a sudden, rapid increase in intraluminal esophageal pressure causes full thickness perforation of normal underlying esophageal tissue, and is frequently a result of violent retching or vomiting, usually after an alcoholic binge. Patients with negative esophagograms in whom esophageal perforation is still suspected on clinical grounds may undergo CT ; in such cases, findings of extraluminal gas in the mediastinum are highly suggestive of esophageal perforation (Fig. 11). Where this has occurred, CT is also useful for determining the extent of extraluminal gas and fluid in the mediastinum and for monitoring patients who are treated nonsurgically (24).

Bottom Line: Barium studies are useful for the evaluation of mucosal surface lesions but provide little information about the extramucosal extent of disease.Computed tomography and magnetic resonance imaging, on the other hand, permit the assessment of wall thickness, mediastinal involvement, adjacent lymphadenopathy, and distant spread.In diseases such as fibrovascular polyps, duplication cysts, scleroderma, trauma, caustic esophagitis, hiatal hernia, esophageal diverticulum, achalasia, and paraesophageal varices, the findings of imaging studies are specific, obviating the need for further invasive diagnostic work-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT
Benign esophageal lesions occur in various diseases. Barium studies are useful for the evaluation of mucosal surface lesions but provide little information about the extramucosal extent of disease. Computed tomography and magnetic resonance imaging, on the other hand, permit the assessment of wall thickness, mediastinal involvement, adjacent lymphadenopathy, and distant spread. In diseases such as fibrovascular polyps, duplication cysts, scleroderma, trauma, caustic esophagitis, hiatal hernia, esophageal diverticulum, achalasia, and paraesophageal varices, the findings of imaging studies are specific, obviating the need for further invasive diagnostic work-up. The advent of helical computed tomography and its volume data set allows the acquisition of multiplanar images, and magnetic resonance imaging is useful both for this and for tissue characterization. Thus, multiplanar cross-sectional imaging further extends the role of imaging modalities to the evaluation of benign esophageal lesions. Through an awareness of the multiplanar cross-sectional appearances of various benign esophageal lesions, the radiologist can play an important role in the detection, diagnosis, further diagnostic planning, and treatment of the diseases in which they occur.

Show MeSH
Related in: MedlinePlus