1.Radiological imaging of esophageal lesions. Dr/ ABD ALLAH NAZEER. MD.

2. Esophageal ring due to muscular contraction. Esophageal A-ring due to muscular contraction. 3. Esophageal B-ring. 4. Achalasia. 5. Achalasia of the cardia. 6. Diffuse esophageal spasm. 7. Zenker's diverticulum. 8. Zenker's diverticulum on chest film, barium study and CT. 9. Killian-Jamieson diverticulum: AP and lateral view 10. Diverticulum. 11. THORACIC DIVERTICULUM 12. 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 13. Large epiphrenic diverticulum. 14. ESOPHAGEAL VARICES. 15. 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). 16. Sliding hernia. 17. Para-esophageal hernia. 18. 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 19. 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 20. CANDIDA ESOPHAGITIS. 21. Cytomegalovirus esophagitis. Cohn's esophagitis. 22. T.B esophagitis. Eosinophilic esophagitis. 23. Barrett's esophagus. 24. 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) 25. Post-corrosive stricture. 26. Strictures. 27. 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. 28. Post-corrosive stricture Osteophytes (arrow) can impinge on the esophagus and hypopharynx. 29. Multiple strictures (arrows). 30. 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. 31. Boerhaave's syndrome. 32. 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. 33. Mallory-Weiss tear 34. 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. 35. Esophagus hematoma. 36. Dissecting intramural hematoma resulting in double lumen. Intramural extravasation (arrow) after distal dilation for achalasia 37. 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. 38. 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. 39. Granular cell myoblastomas, an uncommon benign tumor. Fibrovascular polyp. 40. A foregut duplication cyst is a congenital cyst.Esophageal duplication. 41. LEFT: Small polypoid carcinoma. RIGHT: Large polypoid lesion. 42. Adenocarcinoma of the distal esophagus. 43. Submucosal or intramural mass. 44. 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 45. 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) 46. 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 47. Malignant mass at the distal esophagus. 48. Leiomyosarcoma of the esophagus. 49. Esophageal obstruction due to metastatic mediastinal lymph nodes. 50. Uphill varices in a patient with cirrhosis. 51. Downhill varices in a patient with a superior vena cava obstruction 52. Aberrant right subclavian artery 53. Right aortic arch with aberrant left subclavian artery. 54. Normal and abnormal aortic arch impression on the esophagus. 55. Coarctation: 'Reverse figure 3' indention of esophagus 56. Thank You