•Arises in the distal
of the esophagus,
just above diaphragm
(arrow) that probably
and relaxation of the
ESOPHAGEAL VARICES :
The characteristic radiographic appearance
1. Serpiginous filling defects which
appear as round or oval filling
defects resembling the beads of a
rosary( dilated venous structures) (
2. Changes size and appearance
with variations in intrathoracic
pressure and collapse with
esophageal peristalsis and
3. Varices related to portal
hypertension are most commonly
demonstrated in the lower third of
4. In portal hypertension ;
common accompanying gastric
Air-contrast esophagram shows thick esophageal mucosal folds
(arrows) and an ulcer (arrowhead) due to GERD.
Single contrast esophagram shows stricture (arrow) and sliding
INFECTIOUS ESOPHAGITIS : Increasingly common because of
the use of steroid and cytotoxic drugs, disseminated malignancy,
and increasing incidence of acquired immunodeficiency syndrome
Radiographic findings include
1. Abnormql esophageal motility ( dilated,
atonic esophagus ) is often an early stage
2. Irregular, nodular, plaque-like mucosal
pattern ( arrow), irregular folds(arrowhead)
with marginal serrations ( shaggy appearance )
3. Multiple ulcerations of various sizes
4. Frequently involve the entire thoracic
Most severe corrosive injuries are caused by alkalis
Barium study is unnecessary during acute phase.
1. Diffuse superficial or deep ulceration
involving long portion of the distal
2. Abnormal motility
3. Fibrotic healing results in a long
esophageal stricture ( arrow) that
extends down to the cardioesophageal
Note : barium was aspirated into left main
Boerhaave's syndrome is rupture of the esophageal wall.
It is most often caused by excessive vomiting in eating
disorders such as bulimia although it may rarely occur in
extremely forceful coughing or other situations, such as
obstruction by food.
Boerhaave's syndrome is a transmural or full-thickness
perforation of the esophagus, distinct from Mallory-
Weiss syndrome, a non-transmural esophageal tear also
associated with vomiting.
These syndromes are distinct from iatrogenic perforation,
which accounts for 85-90% of cases of esophageal
rupture, typically as a complication of an endoscopic
procedure, feeding tube, or unrelated surgery.
A Mallory-Weiss tear results from prolonged and
forceful vomiting, coughing or convulsions.
Typically the mucous membrane at the junction of
the esophagus and the stomach develops
lacerations which bleed, evident by bright red
blood in vomitus, or bloody stools.
It may occur as a result of excessive alcohol
This is an acute condition which usually resolves
within 10 days without special treatment.
These unusual lesions have been associated with
increased esophageal intraluminal pressure, most
often vomiting, instrumentation, and
anticoagulation or bleeding disorders.
Some are spontaneous.
Blunt trauma is a rare cause.
Hematomas are self-limited and almost never
progress to perforation.
Most esophageal hematomas resolve in 1-2 weeks
with conservative treatment.
A. Large Polypoid ( often
fungating ) filling defect
(arrow) with overhanging
edge (yellow arrow)
B. Large ulcer niche (yellow
arrow) within a bulging
mass (ulcerated mass)
Major radiographic appearances
Major radiographic appearances.
A. Encircling mass with
narrowing (green arrow)
and shelf like margins
B. Nodular thickened folds
(varicoid type) (black arrow);
Extension of the tumor
PSEUDO-ACHALASIA caused by direct spread to the
distal esophagus from gastric carcinoma.
Radiographic findings :
1. Irregularly, narrowed
and nodular( arrowhead),
(arrow), lesion at distal
2. Rapid transition
between normal and
3. Dilatation of proximal