Esophagus Flashcards
boundaries: nasopharynx, oropharynx, hypopharynx
Nasopharynx: Extends from the base of the skull to the soft palate.
Oropharynx: Located behind the mouth and extends from the uvula to the hyoid bone.
Hypopharynx: Extends from the hyoid bone to the cricopharyngeus muscle, which is located at the lower end of the cricoid cartilage.
cricopharyngeus muscle location
C5-C6
upper esophageal sphincter; pharynx vs cervical esophagus
diaphgragmatic hiatus for esophagus
T10
anatomic rings of distal esophagus
A: muscular
B: mucosal
C: diaphgragmatic impression
esophageal web
anterior infolding/indentation of upper esophagus; cause of dysphagia
association with anemia (Plummer Vinson syndrome) and upper esophageal carcinoma
Schatzi ring
focal narrowing of mucosal ring (B) of distal esophagus (intermittent dysphagia)
most sensitive study for schatzi ring
upper GI > endoscopy
focal circumferential constriction near GEJ, usually associated with hiatal hernia
do not allow passage of 12 mm tablet
ddx for circumferential esophageal constriction
focal striction, muscular esophageal ring (A ring); esophageal cancer, esophageal web (usually in cervical esophagus; rarely circumferential)
types of esophagitis
reflux, barret, infectious, medication, Crohn
peptic esophagitis
exposure of esophageal mucosa to acidic gastric secretions > ulcerations > strictures
seen with GERD, scleroderma, zollinger ellisen
reflux esophagitis on imaging
thickened distal esophageal folds
chronic esophagitis on imaging
scarring; smoothly tapered stricture above GEJ
barrett esophagus
metaplasia of squamous epithelium to gastric type adenomatous mucosa»_space; esophageal carcinoma
imaging of barrett esophagus
featureless distal esophagus
infectious esophagitis types
candidiasis, herpes, CMV/HIV
esophageal vs herpes vs CMV/HIV esophagitis imaging
esophageal: shaggy, scattered plaque like lesions
herpes: discrete small ulcerations; scattered throughout esophagus
CMV/HIV: large flat ovoid ulcer
medication esophagitis
ulcer at aortic arch/distal esophagus (areas of relative narrowing)
crohn esophagitis
small bowel/colon, typically
apthous ulcers–discrete ulcers with mounds of edema may become confluent
stricture types
peptic, barret esophagus, malignant, caustic/NG, radiation, external compression
location of barrett esophagus
mid esophagus above metaplastic adenomatous transition; higher than peptic strictures since adenomatous tissue is acid resistant
shouldered margins with stricture
circumferential luminal narrwing by mass
caustic stricture
long, smooth, narow
1-3 months after caustic ingestion/NG tube placement»_space; increased risk of cancer wiith long lag time (20 years)
radiations tricture
long, smooth, narrow; spares GE junction
amount of radiation to cause radiation stricture/time course of radiation stricture
> 50 Gy
1-3 weeks after radiation therapy; strictures develop 4-8 months after
benign mesenchymal tumors
GIST, leomyoma, lipoma, hemangioma
smooth round submucosal filling defect
size of esopageal adenomas
<1.5, resected endoscopically
benign lesion with malignant potential
inflammatory polyp
enlarged gastric fold protruding into lower esophagus; usually associated with reflux
fibrovascular polyp
pedunculated mass of mesenchymal elements; no malignant potential (unlike adenomas)
typically occur in cervical esophagus (regurgitation of fleshy mass)
esophageal varices
commonly due to portal hypertnesion
uphill varices: portal HTN; distal esophagus (left gastric, periesophageal venous plexus)
downhill varices: SVC obstruction, proximal esophagus (supreme intercostal veins, bronchial, inferior thyroid)
foregut duplication cysts
esophagus: squamous epithelium; posterior mediastinum (appears similar to leiomyoma on esophagram)
bronchogenic: respiratory epithelium
neurenteric cyst: associated with vertebral body anomalies
common location for bony vs meat foreign objects to get stuck
bony: cervical esophagus
meat: GE junction
how long does food impaction raise concern for transmural ischemia
> 24 hrs; transmural ischemia > esophageal perforation
esophageal carcinoma
SCC or adenocarcinoma
SCC: upper/mid esophagus; smoking/alcohol, celiac, plummer-vinson, achalasia, HPV
adenocarcinoma: distal esophagus/stomach; chronic reflux/Barrett esophagus
appearance of esophageal carcinoma
esophagram: plaque like lesion, polypoid lesion, focal wall irregularity ; stricture with shouldered edge/irregular contour
varicoid appearance that does not change shape with peristaltic waves (unlike real varices)
common mets to esophagus
gastric, lung, breast; mediastinal mets from mid esophagus common
contraction wave types
primary: normal, physiologic wave initated by swallow
secondary: norma, physiologic wave initiated by bolus
tertiary: nonpropulsive contraction; no esophageal clearing
vigorous achalasia
less severe form; repetitive nonpropulsive contractions
achalasia; treatment
motility disorder; unable to relax due to abnormality of myenteric ganglia in Auerbach plexus
treat: heller myomectomy
secondary achalasia
Chagas disease
complications of achalasia
esophageal cancer; candida infection from stasis
imaging appearance of achalasia
dilated esophagus with birds beak stricture at GE junction
pseudoachalasia
obstructing GE junction cancer
diffuse esophageal spasm
nonpropulsive esophageal contractions which cause corkscrew or shish kebab appearance
nutcracker esophagus
high amplitude contractions on manometry with chest pain; related to esophageal spasm
types of esophageal dierticula
pulsion diverticula, traction diverticula, zenker, KJ, pseudodiverticulosis
pulsion vs traction diverticula
pulsion: increased pressure; common in US
traction: traction of adjacent structures; TB mediastinal adenopathy (RARE)
Zenker diverticula
failure of cricopharyngeus to relax > elevated hypopharyngeal pressure»_space; posterior protrusion
hypertrophy of cricopharyngeus muscle
treatment: myotomy cripharyngeus, diverticulopexy/diverticulectomy
presentation: halitosis, aspiration, regurgitation of undigested food
KJ diverticulum
weakness below attachment of cricopharyngeus muscle; more often bilateral
protrude anteriorly; seen on lateral view
pseudo Zenker
barium trapped in pharyngeal contraction wave
pseudodiverticulosis
multiple tiny outpouchings caused by dilated submucosal glands
analogous to Rokitansky Aschoof sinuses of gallbladder
smooth stricture
feline esophagus
normal variant; multiple transverse folds
aberrant right subclavian artery (normal left arch) on esophagus
travels posterior to esophagus; rarely produces dysphagia
smooth indentation on posterior esophagus
scleroderma sophagus
excess collagen deposition»_space; lack of peristalsis in distal esophagus due to smooth muscle atrophy and fibrosis»_space; esophageal dilation
secondary candidiasis/aspiration pneumonia
can be seen before skin changes
types of esophageal hernias
hiatal vs paraesophageal hernia
hiatal hernia
gastric fold seen above diaphragm; sliding (common) or short (secondary to reflux)
paraesophageal hernia
GE junction below diphragm; stomach herniates through to chest
more prone to strangulation
