Esophagus

Question 1

Cervical esophagus, extrinsic impression

Answer 1

• Cricopharyngeus • Postcricoid impression • Thyroid/parathyroid enlargement • Lymphoid hyperplasia: allergy, infection, post-tonsillectomy • Abscess, hematoma • Anterior marginal osteophyte, anterior herniation of intervertebral disc, neoplasm, inflammation

Question 2

Thoracic esophagus, extrinsic impression

Answer 2

• Normal structures: aortic arch, left mainstem bronchus, left inferior pulmonary vein • Aortic structures: right aortic arch, cervical aortic arch, double aortic arch, coarctation of aorta, aortic aneurysm/tortuosity • Nonaortic vascular structures: aberrant right subclavian artery, aberrant left pulmonary artery (pulmonary sling), TAPVR • Cardiac/pericardial structures: left atrium and ventricle; effusion, tumor, cyst • Mediastinal mass: tumor, lymph node enlargement, duplication cyst, neurenteric cyst with hemivertebrae, spina bifida, scoliosis • Pulmonary mass

Question 3

Esophagus, discrete filling defect

Answer 3

• Benign tumor: leiomyoma, fibrovascular polyp, papilloma, inflammatory esophagogastric polyp, adenoma • Malignant tumor: SCC, adenocarcinoma, lymphoma, spindle cell sarcoma, gastric carcinoma with upward extension, breast or lung metastases, laryngeal or thyroid carcinoma by direct extension • Varices • Foreign bodies

Question 4

Esophagus, fistula

Answer 4

• Congenital, s/p TEF repair (neonates) • Malignancy: esophageal carcinoma after radiation therapy, bronchogenic carcinoma • Perforation: iatrogenic, spontaneous, foreign body • Corrosive esophagitis • Inflammatory disease: TB, histoplasmosis, actinomycosis, Crohn’s disease

Question 5

Abnormal esophageal motility

Answer 5

• Esophagitis • Neuropathy: CVA, postvagotomy syndrome, IDDM, amyloid, pseudoobstruction, alcoholism • Achalasia • Chagas disease • Scleroderma • Connective tissue disease: SLE, RA, polymyositis, dermatomyositis • Malignancy • Striated muscle disorders: myasthenia gravis • Presbyesophagus

Question 6

Esophagus, tertiary contractions

Answer 6

• Presbyesophagus • Diffuse esophageal spasm • Esophagitis • Early achalasia • Neuromuscular disorders • NL variant in elderly

Question 7

Esophagus, narrowing

Answer 7

• Esophageal web (Plummer-Vinson syndrome), lower esophageal ring/Schatzki ring • Infection: candidiasis • Inflammation: reflux esophagitis, corrosive esophagitis, Barret’s esophagus (reticular mucosa), Crohn’s disease, eosinophilic esophagitis • Drugs: tetracycline, potassium chloride, ascorbic acid, quinidine • Neoplasm: SCC, adenocarcinoma, gastric carcinoma, breast and lung metastases, lymphoma • Iatrogenic: post-surgical stricture, post-nasogastric tube intubation, radiation injury • Epidermolysis bullosa, bullous pemphigoid • Intramural esophageal pseudodiverticulosis

Question 8

Esophagus, nodules

Answer 8

• Candidiasis • Reflux esophagitis • Glycogenic acanthosis • Superficial spreading esophageal carcinoma • Esophageal papillomatosis • Acanthosis nigricans (rare) • Cowden’s disease • Leukoplakia

Question 9

Esophagus, ulceration

Answer 9

• Inflammation: reflux esophagitis, Barret’s esophagus, corrosive esophagitis, drug-induced esophagitis, radiation esophagitis • Infectious: candidiasis, herpes, CMV, HIV, TB, Crohn’s disease • Neoplasm: carcinoma, lymphoma • Mimics: intramural pseudodiverticulosis, Mallory-Weiss tear

Question 10

Esophagus, diverticula

Answer 10

• Pharyngeal: Zenker’s (pulsion) • Midesophageal: traction • Distal: epiphrenic (pulsion)

Question 11

Esophageal cancer risk factors

Answer 11

• ETOH, tobacco • Achalasia (squamous carcinoma), scleroderma (adenocarcinoma) • Head & neck cancer • Tylosis • Plummer-Vinson syndrome • Lye ingestion

Question 12

Esophagus, surgical procedures

Answer 12

• Reconstruction: gastric pull-through, colonic interposition, direct anastamosis (EA) • Antireflux: Nissan fundoplication, Belsey Mark 4 fundoplication, Angelchik prosthesis (sialastic) • Antivarices: esophageal resection and reanastomosis with splenectomy, vagotomy, pyloroplasty • Procedures for motility: cricopharyngeal myotomy, Heller myotomy (with Belsey 2700 fundoplication)

Question 13

Pharyngeal mass

Answer 13

• Malignancy • Mucous retention cyst • Laryngocele • S/p total laryngectomy • Post-radiation therapy

Question 14

Answer 14

Candida Esophagitis

Question 15

Answer 15

Herepes Esophagitis

Double-contrast esophagram is best imaging study
Herpes: Multiple, small, discrete punched-out ulcers on background of normal mucosa
CMV and HIV: 1 or more large, flat ulcers
HPV: Multiple papillary excrescences
EBV: Deep, linear ulcers