Esofageal gröt sip av bonn

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In Esophagus II we will discuss:

• Strictures
• Acute esophageal syndromes.
• Benign and malignant neoplasms.
• Vascular impressions.

The table shows common and uncommon causes of esophageal strictures.

To the far left fryst vatten an image of 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.

Here an image of a long, symmetric tapered benign stricture months after radiotherapy.

Here are images of a patient with a benign stricture high in the esophagus (arrow).
There fryst vatten bilateral lower lobe lung consolidation due to repeated aspiration.

Approximately 5,000-15,000 cases of caustic ingestion occur in the US every year.
About 50%-80% occur in the pediatric population.
On the left a high stricture (arrow) following caustic ingestion

Osteophytes (arrow) can påverka on the esophagus and hypopharynx.

However they rarely cause symptoms.

Multiple structures are uncommon.
The table shows diseases that may present with multiple esophageal strictures.

Here fryst vatten an image of a patient with benign pemphigoid.
Mucosal bullae have led to multiple strictures (arrows).

This image fryst vatten of a patient with benign epidermolysis bullosa.
Multiple strictures (arrows) are a residual of mucosal bullous disease.
Extensive bullous skin disease has led to webbed fingers and contractions.

Corrosive ingestion can result in multiple strictures.

In the table on the left are etiologies of an acute esophageal syndrome.

Boerhaave syndrome

Boerhaave syndrome fryst vatten rupture of the esophageal wall.
It fryst vatten most often caused bygd excessive vomiting in eating disorders such as bulimia although it may rarely occur in extremely forceful coughing or other situations, such as obstruction bygd food.

Boerhaave syndrome fryst vatten a transmural or full-thickness perforation of the esophagus, distinct from Mallory-Weiss syndrome, a nontransmural 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.

This image fryst vatten of a patient with Boerhaave syndrome.
Chest radiographs show pneumomediastinum (arrows).
Esophagram with extravasated vatten soluble contrast ämne in left hemithorax (asterisk)

Perforation fryst vatten almost always on the left side of distal esophagus.
Radiographs show mediastinal gas, effusion, and later pneumothorax.
Esophagram fryst vatten used to confirm leak, first with water-soluble contrast, then barium if no leak fryst vatten demonstrated.

On the left a patient with Boerhaave syndrome.
The barium study shows extraluminal gas (arrow) without contrast extravasation.

CT shows extraluminal gas (arrows).
Rent of distal left esophagus confirmed at surgery.
CT can show small amounts of extraluminal gas or extravasation not visible on radiographs or esophagram.

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 bygd bright red blood in kräkning, or bloody stools.
It may occur as a result of excessive alcohol ingestion.

This fryst vatten an acute condition which usually resolves within 10 days without special treatment.

On the left a patient with a Mallory-Weiss tear.
fläck films show barium (arrows) in linear mucosal tear nära gastroesophageal junction.

Tears may be in distal esophagus, gastric fundus, or extend across the GE junction.

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 fryst vatten a rare cause.
Hematomas are self-limited and almost never progress to perforation.

Most esophageal hematomas lösa in 1-2 weeks with conservative treatment.

On the left a patient with an esophagus hematoma.
He presented with chest pain and dysphagia after vomiting.
Aside from tortuous huvudartär chest radiograph fryst vatten normal.
The barium study shows a narrowed lumen (arrows) on AP view and flattened lumen on sidledes view (arrowheads) suggestive of a intramural hematoma.

On CT the diagnosis of an intramural hematoma was confirmed.
A high density mural hematoma (arrowhead) fryst vatten seen next to NG tube (arrow).
Following conservative treatment, six months later the barium study was normal.

On the left a patient who had a complicated endoscopy.

Instrumentation caused a mucosal tear and dissecting intramural hematoma resulting in double lumen with separating stripe of mucosa (arrows).

On the far left an intramural extravasation (arrow) after distal dilation for achalasia.
In the mittpunkt an intramural extravasation (arrow) after complicated endoscopy.

On the right a perforation after biopsy with extravasation of contrast ämne (arrow).

Here a list of benign esophageal masses.

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.

On the left an asymptomatic patient with a leiomyoma.

On the chest spelfilm an abnormal opacity fryst vatten seen behind the heart (arrow).

The barium study demonstrates a lobulated mass (arrow) that does not obstruct despite its large storlek.

Mucosal lesions are indicated bygd mucosal irregularities.
Submucosal intramural lesions producera smooth filling defects, and in kontur, the margins often form eller gestalt close to a right vinkel with the esophageal vägg.

Extrinsic lesions tend to struktur längre obtuse angles if not fixed to the esophageal vägg, and their epicenter may be outside the esophagus. In practice, the location of a skada may be difficult to determine.

On radiograph, tumor (arrows) protrudes into azygoesophageal recess.
On esophagram, the underlägsen margin of this intramural sår forms close to a right vinkel (arrow) with esophageal vägg.

A calcified esophageal mass fryst vatten almost always a leiomyoma.
On the left a patient with a calcified esophageal sår (arrows) protrudes into azygoesophageal recess on radiograph.

lesion (arrow) on CT and surgical specimen radiograph showing calcification.

On the left a patient with granular fängelse myoblastomas, an uncommon benign tumor.
These two lesions (arrows) are nonspecific in appearance, but the proximal skada does demonstrate overhanging and right vinkel margins indicating mural location.

Fibrovascular polyp

Pedunculated fibrovascular polyps are rare lesions, that are difficult to diagnose on esophagrams.
Their movement during the examination produces an inconstant position.
Their shape may be suggestive as in this patient.
The stalk fryst vatten often difficult to identify.

Duplication

On the left a patient with an esophageal kopiering.

The findings on the barium study are non-specific.
lesion (arrows) fryst vatten visible behind the heart on radiograph.

Esophageal narrowing (arrows) fryst vatten caused bygd kopiering.

A foregut kopiering cyst fryst vatten a congenital cyst.
In the case on the left it displaces hypopharynx and opacified esophagus (arrow) posteriorly and trachea and larynx (asterisk) anteriorly.

Here a list of malignant esophageal masses.

Early and small esophageal carcinoma are not synonymous.
Early esophageal carcinoma fryst vatten limited to the mucosa, submucosa with no lymph node metastases.
Most are small ( Small esophageal carcinoma fryst vatten defined bygd the storlek of the skada, a diameter So an early carcinoma may be small, but a small carcinoma may be invasive or metastatic and thus not an early carcinoma.

This image fryst vatten of a patient with an early esophageal carcinoma.
skada fryst vatten not visible on single contrast esophagram.
Air-contrast esophagram shows surface irregularity (arrows) indicating a mucosal lesion.
This was both a small skada and a pathologically early squamous carcinoma.

RIGHT: Large polypoid lesion.

Advanced carcinoma has many gross appearances:

• Polypoid
• Varicoid
• Infiltrative
• Ulcerative
• Superficial spreading
• Stricture
• Pseudoachalasia

On the left two cases of polypoid carcinoma.

This image fryst vatten of a patient with an infiltrative ulcerated carcinoma.
This lesion has an abrupt transition forming an acute vinkel and overhanging edge.
This indicates mural involvement and fryst vatten different than obtuse angles usually produced bygd extrinsic lesions that are not fixed to the esophagus.

These images are of a patient with a varicoid carcinoma.
Unchanging appearance of filling defects indikera tumor rather than varices.
Note skarp upper margin of sår and ulceration (arrows)

RIGHT: Superficial spreading carcinoma.

To the far left an image of a patient with a varicoid carcinoma.
Long lobulations simulate varices but did not vary during fluoroscopy.
Note large irregular folds and soft tissue mass (arrow) of gastric fundus

Next to it an image of a patient with a superficial spreading carcinoma.
Extensive superficial spread involves distal esophagus.
This appearance can be seen with both early and advanced lesions.