a radiological overview of esophageal disorders.

1. Radiological imaging
of esophageal lesions.

7. Esophageal ring due to
muscular contraction.
Esophageal A-ring due to
muscular contraction.

8. Esophageal B-ring.

10. Achalasia.

11. Achalasia of the cardia.

13. Diffuse esophageal spasm.

16. Zenker's diverticulum.

17. Zenker's diverticulum on chest film, barium study and CT.

18. Killian-Jamieson diverticulum: AP and lateral view

19. Diverticulum.

20. THORACIC DIVERTICULUM

21. EPIPHRENIC DIVERTICULUM
•Arises in the distal
of the esophagus,
just above diaphragm
•Pulsion diverticulum
(arrow) that probably
related to
incoordination of
esophageal peristalsis
and relaxation of the
lower esophageal
sphincter

22. Large epiphrenic diverticulum.

24. ESOPHAGEAL VARICES.

25. 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) (
arrowhead).
2.Changes size and appearance
with variations in intrathoracic
pressure and collapse with
esophageal peristalsis and
distension.
3. Varices related to portal
hypertension are most commonly
demonstrated in the lower third of
the esophagus.
4. In portal hypertension ;
common accompanying gastric
varices(arrow).

27. Sliding hernia.

28. Para-esophageal hernia.

31. Air-contrast esophagram shows thick esophageal mucosal folds
(arrows) and an ulcer (arrowhead) due to GERD.
Single contrast esophagram shows stricture (arrow) and sliding
hiatus hernia

32. INFECTIOUS ESOPHAGITIS : Increasingly common because of
the use of steroid and cytotoxic drugs, disseminated malignancy,
and increasing incidence of acquired immunodeficiency syndrome
CANDIDA ESOPHAGITIS
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
esophagus

33. CANDIDA ESOPHAGITIS.

34. Cytomegalovirus esophagitis. Cohn's esophagitis.

35. T.B esophagitis. Eosinophilic esophagitis.

37. Barrett's esophagus.

38. CORROSIVE ESOPHAGITIS.
Most severe corrosive injuries are caused by alkalis
Barium study is unnecessary during acute phase.
Radiographic findings;
1. Diffuse superficial or deep
ulceration involving long portion
of the distal esophagus
2. Abnormal motility
3. Fibrotic healing results in a long
esophageal stricture ( arrow) that
extends down to the cardioesophageal
junction.
Note : barium was aspirated into left main
bronchus(green arrow)

39. Post-corrosive stricture.

40. Strictures.

41. Symmetric tapered benign stricture
months after radiotherapy.
Benign stricture high in the esophagus
(arrow). There is bilateral lower lobe lung
consolidation due to repeated aspiration.

42. Post-corrosive stricture
Osteophytes (arrow) can impinge on
the esophagus and hypopharynx.

43. Multiple strictures (arrows).

45. Boerhaave syndrome:
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.

46. Boerhaave's syndrome.

47. Mallory-Weiss tear
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
ingestion.
This is an acute condition which usually resolves
within 10 days without special treatment.

48. Mallory-Weiss tear

49. Esophageal hematoma:
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.

50. Esophagus hematoma.

51. Dissecting intramural hematoma
resulting in double lumen.
Intramural extravasation (arrow)
after distal dilation for achalasia

53. Leiomyomas
Leiomyomas are the most common benign esophageal
neoplasm and are often large yet nonobstructive.
Gastrointestinal stromal tumors (GIST) are least common
in the esophagus.

54. A calcified esophageal mass is almost always a leiomyoma.
On the left a patient with a calcified esophageal lesion (arrows)
protrudes into azygoesophageal recess on radiograph.

55. Granular cell myoblastomas, an uncommon benign tumor.
Fibrovascular polyp.

56. A foregut duplication cyst
is a congenital cyst.
Esophageal duplication.

58. LEFT: Small polypoid carcinoma.
RIGHT: Large polypoid lesion.

59. Adenocarcinoma of the distal esophagus.

60. Submucosal or intramural mass.

61. ADVANCED STAGE
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) (arrow)
Major radiographic appearances

62. Major radiographic appearances.
Advanced stage
A. Encircling mass with
irregular luminal
narrowing (green arrow)
and shelf like margins
(black arrow)
B.Nodular thickened folds
(varicoid type) (black arrow);
Extension of the tumor
(green arrow)

63. PSEUDO-ACHALASIA caused by direct spread to the
distal esophagus from gastric carcinoma.
Radiographic findings :
1.Irregularly, narrowed
and nodular( arrowhead),
sometimes ulcerated
(arrow), lesion at distal
esophagus
2. Rapid transition
between normal and
abnormal part.
3. Dilatation of proximal
esophagus

64. Malignant mass at the distal esophagus.

66. Leiomyosarcoma of the esophagus.

67. Esophageal obstruction due to metastatic mediastinal lymph nodes.

69. Uphill varices in a patient with cirrhosis.

70. Downhill varices in a patient with a superior vena cava obstruction

71. Aberrant right subclavian artery

72. Right aortic arch with aberrant left subclavian artery.

73. Normal and abnormal aortic arch impression on the esophagus.

74. Coarctation: 'Reverse figure 3' indention of esophagus

75. Thank
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