Aortic Esophagus Thickness

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Figure 4-30 Normal esophagus (arrow) on CT at the level of (A) the great vessels, (B) the aortic arch, (C) the heart, (D) the diaphragm. The normal esophagus Is collapsed and surrounded by periesophageal fat planes.

Figure 4-30 Normal esophagus (arrow) on CT at the level of (A) the great vessels, (B) the aortic arch, (C) the heart, (D) the diaphragm. The normal esophagus Is collapsed and surrounded by periesophageal fat planes.

Image Level Arch Aorta

Figure 4-31 Contrast-enhanced spiral CT of the chest in a 53-year-old man with chest pain demonstrates marked circumferential thickening of the distal esophagus (arrows) measuring 1.5 cm in thickness. Esophageal cancer was confirmed at endoscopy.

Esophagus And Aorta

Figure 4-32 A, Spiral CT with intravenous and oral contrast in a 63-year-old man with newly diagnosed esophageal cancer reveals an area of circumferential thickening in the distal esophagus, at the gastroesophageal junction. B, A scan of the upper chest demonstrates dilatation of the proximal esophagus, which is filled with oral contrast (arrow). This is compatible with partial obstruction by the tumor.

Figure 4-32 A, Spiral CT with intravenous and oral contrast in a 63-year-old man with newly diagnosed esophageal cancer reveals an area of circumferential thickening in the distal esophagus, at the gastroesophageal junction. B, A scan of the upper chest demonstrates dilatation of the proximal esophagus, which is filled with oral contrast (arrow). This is compatible with partial obstruction by the tumor.

Junction Cxr

Figure 4-33 Contrast-enhanced spiral CT of the chest In a 67-year-old man with esophageal cancer demonstrates (A) a 1.5 cm mass along the right wall of the distal esophagus (arrow). B, A scan of the upper abdomen In the same patient reveals adenopathy around the celiac axis and in the periportal region (arrows).

Figure 4-33 Contrast-enhanced spiral CT of the chest In a 67-year-old man with esophageal cancer demonstrates (A) a 1.5 cm mass along the right wall of the distal esophagus (arrow). B, A scan of the upper abdomen In the same patient reveals adenopathy around the celiac axis and in the periportal region (arrows).

Celiac And Women 40s

Figure 4-34 A, Contrast-enhanced spiral CT of the chest reveals marked circumferential thickening of the esophagus compatible with esophageal cancer (arrow). B, There is also thickening at the level of the gastroesophageal junction, indicating extension into the gastric cardia (arrows). C, A coronal reconstruction nicely demonstrates the extent of tumor involvement.

Esophageal Extension Fistula

Figure 4-36 Contrast-enhanced spiral CT in an 83-year-old man with esophageal cancer demonstrates (A) moderate circumferential esophageal thickening (straight arrows) at the level of the main stem bronchi (curved arrows). B, A tracheoesophageal fistula (curved) is identified extending from the tumor to the left mainstem bronchus.

Figure 4-36 Contrast-enhanced spiral CT in an 83-year-old man with esophageal cancer demonstrates (A) moderate circumferential esophageal thickening (straight arrows) at the level of the main stem bronchi (curved arrows). B, A tracheoesophageal fistula (curved) is identified extending from the tumor to the left mainstem bronchus.

Submucosal Nodule Esophagus

Figure 4-37 A, Contrast-enhanced spiral CT in a patient with unresectable esophageal cancer, following esophageal stent placement. There is marked circumferential thickening of the esophagus with increased density of the adjacent mediastinal fat, compatible with local invasion. A fistula is present between the esophageal mass and the left main stem bronchus (arrow). This results in atelectasis and infiltrate in the left lung. B, 3D image in the coronal projection nicely demonstrates the esophageal stent and the communication between the esophagus and airway/lung (arrow).

Figure 4-37 A, Contrast-enhanced spiral CT in a patient with unresectable esophageal cancer, following esophageal stent placement. There is marked circumferential thickening of the esophagus with increased density of the adjacent mediastinal fat, compatible with local invasion. A fistula is present between the esophageal mass and the left main stem bronchus (arrow). This results in atelectasis and infiltrate in the left lung. B, 3D image in the coronal projection nicely demonstrates the esophageal stent and the communication between the esophagus and airway/lung (arrow).

Cysts The Rectum Submucosal

Figure 4-38 A, Contrast-enhanced spiral CT in a 60-year-old man with dysphagia reveals a 3-cm mass in the distal esophagus (arrow). There is a good fat plane demonstrated between the esophageal mass and the aorta (A) and heart (H). B, CT scan of the upper abdomen in the same patient demonstrates a 4 x 6 cm nodal mass (curved arrows) in the gastrohepatic ligament. Squamous cell carcinoma of the esophagus was diagnosed at endoscopy.

Figure 4-38 A, Contrast-enhanced spiral CT in a 60-year-old man with dysphagia reveals a 3-cm mass in the distal esophagus (arrow). There is a good fat plane demonstrated between the esophageal mass and the aorta (A) and heart (H). B, CT scan of the upper abdomen in the same patient demonstrates a 4 x 6 cm nodal mass (curved arrows) in the gastrohepatic ligament. Squamous cell carcinoma of the esophagus was diagnosed at endoscopy.

Gastrohepatic And Esophageal Ligaments

Figure 4-39 Contrast-enhanced spiral CT in a patient with esophageal carcinoma after esophagectomy and gastric pull-up. A, The CT demonstrates a contrast filled intrathoracic stomach, compatible with gastric pull-up (GPU). B, There is a 4 cm low attenuation mass within the liver (arrow) compatible with metastasis.

6cm 4cm Squamous Cell Forehead
Figure 4-40 Contrast-enhanced spiral CT in a 51-year-old woman with a submucosal lesion noted on barium esophagogram demonstrates a low density mass in the esophagus (arrow). This is a biopsy-proven leiomyoma.

Figure 4-41 Contrast-enhanced spiral CT in a 33-year-old man with incidental mass noted on chest x-ray demonstrates a low attenuation cystic mass which is intimately related to the esophagus, compatible with a duplication cyst.

Figure 4-42 Contrast-enhanced spiral CT in 64-year-old male after esophagectomy and gastric pull-up for esophageal cancer demonstrates 6x4 cm fluid collection in the mediastinum (arrow) adjacent to the gastric pull-up (curvedarrow). There is a small amount of air within the collection. This CT appearance is compatible with abscess. There are also small bilateral pleural effusions (small arrows).

Figure 4-43 Contrast-enhanced CT in a patient after esophagectomy with gastric pull-up demonstrates a 12 x 10 x 20 cm lymphocele (arrows), which extends from the posterior left chest (A) into the retroperitoneum (B).

Colonic Pull

Figure 4-44 Contrast-enhanced spiral CT in a 33-year-old HIV-positive man with chest pain demonstrates moderate circumferential thickening of the esophagus (arrow) which is low in density, compatible with edema. There is also increased density within the adjacent mediastinal fat compatible with inflammation. These findings are most compatible with esophagitis in this clinical setting. This was confrmed at endoscopy. Locally invasive esophageal cancer could have a similar CT appearance.

Figure 4-44 Contrast-enhanced spiral CT in a 33-year-old HIV-positive man with chest pain demonstrates moderate circumferential thickening of the esophagus (arrow) which is low in density, compatible with edema. There is also increased density within the adjacent mediastinal fat compatible with inflammation. These findings are most compatible with esophagitis in this clinical setting. This was confrmed at endoscopy. Locally invasive esophageal cancer could have a similar CT appearance.

Figure 4-45 Contrast-enhanced spiral CT in a patient with cirrhosis and portal hypertension demonstrates enhancing esophageal varices.
Spiral Colon Cat

Figure 4-46 Coronal 3D image from contrast-enhanced spiral CT in a patient with cirrhosis and portal hypertension demonstrates large gastroesophageal varices (arrows). There is moderate splenomegaly. L, liver; S, spleen; PV, portal vein; SV, splenic vein.

Figure 4-47 Spiral CT of the chest with oral and intravenous contrast in a patient with a large right lung mass identified on chest radiograph demonstrates marked dilatation of the esophagus with retained food mixed with oral contrast. This degree of dilatation is compatible with achalasia.

Conclusion

Since the 1980s, radiologic studies have come to play a critical role in imaging of the gastrointestinal tract. Contrast studies continue to provide important information about both anatomy and function of the esophagus and often serve as a valuable adjunct to endoscopy. With its ability to visualize the esophageal lumen, wall, and adjacent mediastinal organs, CT is useful in the evaluation of both benign and malignant diseases of the esophagus. With continued advances in CT technology, contrast

Figure 4-48 Spiral CT of the chest in a patient with esophageal cancer complaining of chest pain after esophageal stent placement. The CT demonstrates extraluminal air and contrast in the mediastinum (arrows) compatible with perforation.

Esophageal Stent Patient Information

Figure 4-49 Contrast-enhanced spiral CT in a 64-year-old man with dysphagia demonstrates a large aberrant right subclavian artery (straight arrows) arising from a left aortic arch (curved arrow). The aberrant vessel crosses behind the esophagus (small arrow) causing extrinsic compression. This Is an example of dysphagia lusorla.

References

1. Andersen, H.A., Bernatz, P.E., and Grindlay, J.H.: Perforation of the esophagus after use of a digestive agent: Report of a case and experimental study. Ann. Otol. Rhinol. Laryngol., 68:890, 1959.

2. Balthazar, E.J., Megibow, A.J., Hulnick, D., et al.: Cytomegalovirus esophagitis in AIDS: Radiographic features in 16 patients. Am. J. Radiol., 149:919, 1987.

3. Balthazar, E.J., Naidich, D.P., Megibow, A.J., and Lefleur, R.S.: CT evaluation of esophageal varices. Am. J. Radiol., 148:131, 1987.

4. Banfield, W.J., and Hurwitz, A.L.: Esophageal stricture associated with nasogastric intubation. Arch. Intern. Med., 134:1083, 1974.

5. Bladergroen, M.R., Lowe, J.E., and Postlethwait, R.W.: Diagnosis and recommended management of esophageal perforation and rupture. Ann. Thorac. Surg., 42:235, 1986.

6. Blumhagen, J.D., Rudd, T.G., and Christie, D.L.: Gastroesophageal reflux in children: Radionuclide gastroesophagography. Radiology, 135:1001, 1980.

7. Bondi, J.L. Godwin, D.H., and Garrett, J.M.: "Vigorous achalasia": Its clinical interpretation and significance. Am. J. Gastroenterol., 58:145, 1972.

8. Brauer, R.B., Liebermann-Meffert, D., Stein, H.J., et al.: Boerhaave's syndrome: Analysis of the literature and report of 18 new cases. Dis. Esophagus, 10:64, 1997.

9. Braverman, I., Gomori, J.M., Polv, O., and Saah, D.: The role of CT imaging in the evaluation of cervical esophageal foreign bodies. J. Otolaryngol., 22:311, 1993.

10. Brick, I.B., and Palmer, E.D.: Comparison of esophagoscopic and roentgenologic diagnosis of esophageal varices in cirrhosis of the liver. Am. J. Radiol., 73:387, 19 5 5.

11. Bruhlmann, W.E., Zollikofer, C.L., Maranta, E., et al.: Intramural pseudodiverticulosis of the esophagus: Report of seven cases and literature review. Gastrointest. Radiol., 6"; 199, 1981.

12. Buecker, A., Wein, B.B., Neuerburg, J.M., and Guenther, R.W.: Esophageal perforation: Comparison of use of aqueous and barium-containing contrast media. Radiology, 202:683, 1997.

13. Castillo, S., Aburashed, A., Kimmelman, J., and Alexander, L.C.: Diffuse intramural esophageal pseudodiverticulosis: New cases and review. Gastroenterology, 72:541, 1977.

14. Chen, Y.M., Gelfand, D.W., Ott, D.J., and Wu, W.C.: Barrett esophagus as an extension of severe esophagitis: Analysis of radiologic signs in 29 cases. Am. J. Radiol., 145:275, 1985.

15. Chiu, C.L., and Gambach, R.R.: Hypaque pulmonary edema: A case report. Radiology, 111:91, 1974.

16. Cho, K.C., Patel, Y.D, Wachsberg, R.H., and Seeff, J.: Varices in portal hypertension: Evaluation with CT. Radiographics, 15:609, 1995.

17. Cho S.R., Sanders M.M., Turner M.A., et al.: Esophageal intramural pseudodiverticulosis. Gastrointest. Radiol., 6:9, 1981.

18. Cockrill, E.M., Miller, R.E., Chernish, S.M., et al.: Optimal visualization of esophageal varices. Am. J. Radiol., 126:512, 1976.

19. Cole, M.J., Paterson, W.G., Beck, I.T., and DaCosta, L.R.: The effect of acid and bethanechol stimulation in patients with symptomatic hypertensive peristaltic (nutcracker) esophagus: Evidence that this disorder may be a precursor to diffuse esophageal spasm. J. Clin. Gastroenterol., 8:223, 1986.

20. Conces, D.J., Jr., Tarver, R.D., and Lappas, J.C.: The value of opacification of the esophagus by low denisty barium paste in computed tomography of the thorax. J. Comput. Assist. Tomogr., 12:202, 1988.

21. Coulomb, M., Lebas, J.F., Sarrazin, R., and Geindre, M.: Oesophageal cancer extension: Diagnostic contribution and effects of therapy of computed tomography (French). J. Radiol., 62:475, 1981.

22. Daffner, R.H., Halber, M.D., Postlethwait, R.W., et al.: CT of the esophagus. II. Carcinoma. Am. J. Radiol., 133:1051, 1979.

23. Dalinka, M.K., Smith, E.H., Wolfe, R.D., et al.: Pharmacologically enhanced visualization of esophageal varices by Pro-Banthine. Radiology, 102:281, 1972.

24. de Oliveira, J.M., Birgisson, S., Doinoff, C., et al.: Timed barium swallow: A simple technique for evaluating esophageal emptying in patients with achalasia. Am. J. Radiol., 169:413, 1997.

25. de Silva, R., Stoopack, P.M., and Raufman, J.P.: Esophageal fistulas associated with mycobacterial infection in patients at risk for AIDS. Radiology, 175:449, 1990.

26. Desai, R.K., Tagliabue, J.R., Wegryn, S.A., and Einstein, D.M.: CT evaluation of wall thickening in the alimentary tract. Radiographics, 11:771, 1991.

27. Donner, M.W., Silbiger, M.L., Hookman, B., and Hendrix, T.R.: Acid-barium swallows in the radiographic evaluation of clinical esophagitis. Radiology, 87:220, 1966.

28. Dyet, J.F., Bennett, J.R., Buckton, G., and Ashworth, D.: The radiological measurement of oesophageal stricture diameter. Clin. Radiol., 34:641, 1983.

29. Ekberg, O., and Nylander, G.: Webs and web-like formations in the pharynx and cervical esophagus. Diagn. Imaging, 52:10, 1983.

30. Endo M., Takemoto, T., and Shirakabe, H.: Minute lesions of esophageal cancer. Semin. Surg. Oncol., 2:177, 1986.

31. Ferraro P., and Durnanceau, A.: Esophageal diverticula. Chest Surg. Clin. North Am., 4:741, 1994.

32. Foley, M.J., Ghahremani, G.G., and Rogers, L.F.: Re-appraisal of contrast media used to detect upper gastrointestinal perforations: Comparison of ionic water soluble media with barium sulfate. Radiology, 144:231, 1982.

33. Franken E.A., Jr.: Caustic damage of the gastrointestinal tract: Roentgen features. Am. J. Radiol., 118:77, 1973.

34. Fulp, S.R., and Castell, D.O.: Scleroderma esophagus. Dysphagia, 5:204, 1990.

35. Gheorghe, C., Aposteanu, G., Popescu, C., et al.: Long esophageal stricture in Crohn's disease: A case report. Hepatogastroenterology, 45:738, 1998.

36. Glick, S.N.: Barium studies in patients with Barrett's esophagus: Importance of focal areas of esophageal deformity. Am. J. Radiol., 163:65, 1994.

37. Glick, S.N., Teplick, S.K., and Amenta, P.S.: The radiologic diagnosis of Barrett esophagus: Importance of mucosal surface abnormalities on air-contrast barium studies. Am. J. Radiol., 157:951, 1991.

38. Goldenberg, S.P., Burrell, M., Fette, C.G., et al.: Classic and vigorous achalasia: A comparison of manometric, radiographic, and clinical findings. Gastroenterology, 101:743, 1991.

39. Goldman, L.P., and Weigert, J.M.: Corrosive substance ingestion: A review. Am. J. Gastroenterol., 79:85, 1984.

40. Goldstein, H.M., Zornoza, J., and Hopens, T.: Intrinsic disease of the adult esophagus: Benign and malignant tumors. Semin. Roentgenol., 3:183, 1981.

41. Gollub, M.J., and Bains, M.S.: Barium sulfate: A new (old) contrast agent for diagnosis of postoperative esophageal leaks. Radiology, 202:360, 1997.

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