dd’s of esophageal stricture and intra luminal filling defects

Begins at level of C6 and ends at T11. 25cm long 3 constrictions

at cricoid cartilage at aortic arch & left main bronchus where it crosses diaphram

Four anatomical segments for staging purposes

.Cervical Esophagus .Upper Thoracic Esophagus .Middle Thoracic Esophagus .Lower Thoracic Esophagus

An esophageal stricture is a narrowing or tightening of the esophagus that causes swallowing difficulties.

Esophageal stricture can be caused by:

1.Benign1.BenignGastroesophageal reflux (GERD)Injuries caused by an endoscopeLong-term use of a nasogastric (NG) tubeIngestion of corrosives.Treatment of esophageal varices

Symmetric tapered benign stricture months after radiotherapy.

high stricture (arrow) following caustic ingestion.

Corrosive ingestion can result in multiple strictures.

CT showing thick walled esophagus with stenosis of the lumen.

MALIGNANTSquamous cell carcinomaadenocarcinoma

On the far left a stricture (arrow) with irregular mucosal folds at stricture site on air-contrast view. This patient had Barrett's esophagus. Mid esophageal strictures and ulcers are suspicious for Barrett's esophagus.

The two images on the right show a Barrett's esophagus with an irregular stricture due to adenocarcinoma

Typical symptoms include;Dysphagia:Odynophagiaunintended weight lossregurgitation of food or liquids:HeartburnChokingBad taste in mouthhiccups

Barium Swallow Esophageal PH monitoring CT Scan Endoscopy Biopsy

Heart burn Malnutrition Dehyadration Choking Aspiration Pneumonia

On the left images of a patient with a benign stricture high in the esophagus (arrow). There is bilateral lower lobe lung consolidation due to repeated aspiration.

INTRALUMINAL FILLING DEFECTS

Food impaction behind a stricture. Bezoar. Foreign body.

Polyps Lieomyoma-smooth ,rounded indentation. Carcinoma-irregular filling defect usually

with a stricture.

Esohageal polyps.

Leiomyoma esophagus.

Filling defect of esophagus on barium meal with typical proximal &distil shouldering.

Irregular filling defect showing neoplastic growth.

Filling defect on barium meal.

CA bronchus. Mediastinal lymphadenopathy. Aortic aneurysm Anomolous right subclavian artery.

 mediastinal nodes (arrows) that displace the esophagus to right in a patient with bronchogenic carcinoma

Aberrant right subclavian artery

This is the most common thoracic arterial anomaly and rarely causes symptoms. The artery extends up and to the right producing a dorsal diagonal impression on the esophagus (arrows). The CT demonstrates that the aberrant artery (arrow) is last vessel from arch and extends dorsal to trachea and esophagus.