J Korean Soc Radiol.  2013 Jul;69(1):43-51. 10.3348/jksr.2013.69.1.43.

Non-Neoplastic Disorders of the Esophagus

• Hong MJ
• Kim YT

• KMID: 2002889
• DOI: http://doi.org/10.3348/jksr.2013.69.1.43

Abstract

Non-neoplastic disorders of the esophagus include esophagitis, esophageal diverticulum, esophageal injury, foreign body, fistulous formation between the esophagus and the surrounding structures and mucocele. Since these disorders have variable symptoms and radiologic findings, it needs to differentiated from other disorders other than esophageal diseases. Being knowledgeable of CT findings suggest that these disorders can help diagnose non-neoplastic disorders of the esophagus. The purpose of this pictorial essay is to review the CT appearance of non-neoplastic disorders of the esophagus.

MeSH Terms

Diverticulum, Esophageal
Esophageal Diseases
Esophagitis
Esophagus
Foreign Bodies
Mucocele

Figure

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  Fig. 1 Reflux esophagitis in a 45-year-old man. A. Serial axial images show mucosal enhancement and diffuse submucosal edema of the esophagus (arrows), and sliding esophageal hernia (arrowhead). B. Reformatted sagittal image shows diffuse esophageal wall thickening and enhancing mucosa of mid- and lower esophagus (arrowheads). Thickening of esophageal walls is a nonspecific response in various esophageal condition, it is not possible to conclusively identify the cause of wall thickening by the CT appearance alone.

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  Fig. 2 Corrosive esophagitis in a 45-year-old man with ingestion of 10% hydrochloric acid and alcohol 2 hours ago. Serial axial images show diffuse esophageal wall thickening and enhancing mucosa of the esophagus (arrow), and low attenuation wall thickening of the stomach (arrowheads).

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  Fig. 3 Paraesophageal abscess after foreign body removal in an 82-year-old woman. She had the history of foreign body ingestion 5 days ago. A foreign body (fragment of fish) was removed by endoscopic procedure and pus was discharged from the edematous mucosa. Serial axial images show small abscesses (arrows) with wall enhancement along the upper esophagus. These abscesses were resolved on CT obtained 6 days later.

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  Fig. 4 Esophageal diverticulitis of mid-esophagus in a 94-year-old man. A. Axial CT scan shows irregular shaped mass like lesion with central dirty air densities (arrow) in subcarinal and periesophageal areas, suggesting diverticulitis. Also note diffuse wall thickening of left main bronchus (open arrowheads). B. Three dimensional (3D) image of the trachea shows concentric luminal narrowing of left main bronchus (double arrows), suggesting bronchial involvement of esophageal diverticulitis. C, D. Precontrast axial image after treatment (C) shows that irregular mass-like lesion is changed to a well-marginated air cyst (arrow). 3D image after treatment (D) shows normalized left main bronchus and a well-marginated air-filled diverticulum (arrowhead).

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  Fig. 5 Remnant esophageal diverticulum in a 54-year-old man. He had the operation of substernal bypass surgery without esophagectomy due to diverticulum of distal esophagus. A. Axial scan shows an irregular shaped cystic lesion (*) with air-fluid level in the right lower lobe. The cystic lesion is indicative of remnant esophageal diverticulum and irregularity of cystic lesion with air fluid level is suggestive of the possibility of combined infection or esophagorespiratory fistula. Also demonstrate interposed bowel (S) in anterior mediastinum. B. Barium esophagogram shows substernal stomach interposition. Contrast materials cannot be introduced into the remnant esophagus.

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  Fig. 6 Intramural dissection of esophagus in a 78-year-old man. He was complained of abdominal discomfort due to foreign body impaction 10 days ago. A. Serial axial images show fluid-filled, high-attenuation false lumen (open arrows), anterior to true lumen (arrowheads) of the dissected esophagus. B, C. Serial axial (B) and reformatted sagittal images (C) 7 days later show air-filled false lumen (F) anterior to true lumen (arrowheads) of dissected esophagus. It was improved by conservative management.

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  Fig. 7 Diffuse intramural hematoma of esophagus in a 72-year-old woman. Precontrast reformatted sagittal (A) and axial (B) images show high attenuation wall thickening (arrowheads) of the entire esophagus.

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  Fig. 8 Spontaneous esophageal perforation in a 55-year-old man. He was complained of vomiting and chest pain for one day. Serial axial images show pneumomediastinum (arrows) and fluid collection (*) around esophagus (arrowheads).

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  Fig. 9 Tracheoesophageal fistula caused by corrosive ingestion in a 55-year-old man. A. Axial scan shows high attenuation of esophagus (arrow) suggesting intramural hematoma. The posterior wall of left main bronchus is indented by the esophageal lesion. B. Axial image after ingestion of oral contrast media shows the leakage of contrast material from esophagus to both main bronchus.

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  Fig. 10 Tracheoesophageal fistula in a 47-year-old man. He had the history of ingestion of corrosive agents two weeks ago. A, B. Serial axial (A) and reformatted sagittal (B) images show communication (open arrow) between lower trachea (T) and mid-esophagus (arrowhead).

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  Fig. 11 Esophagorespiratory fistula in a 53-year-old woman. She presented chronic cough for 5 years, which was aggravated at night or after food ingestion. Endoscopy showed a fistulous opening in mid-esophagus. A. Serial axial images show abnormal air densities around esophagus (arrowheads), and bronchiectasis and consolidation in the left lower lobe. B. Three dimensional image shows a fistulous tract (*) from the esophagus (E). C. Esophagogram shows the leakage of contrast material from the esophagus to bronchiectasis (open arrow) of the lung through fistulous tract (arrowhead).

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  Fig. 12 Esophageal mucocele in a 47-year-old man. He had the operation of bypass surgery without esophagectomy due to spontaneous esophageal perforation one year ago. A. Serial axial images show thin walled cystic lesion of the entire esophagus (*) with tracheal compression, and interposed bowel (S) in anterior mediastinum. B. Reformatted coronal image shows thin walled cystic lesion (*) of the entire esophagus.

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  Fig. 13 Diffuse esophageal spasm in a 75-year-old man with swallowing difficulty. A. Esophagogram shows diffuse esophageal spasm with marked nonperistaltic contractions and tapered narrowing of distal esophagus. B. Serial axial images show circumferential wall thickening (open arrowheads) of mid- and lower esophagus.

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  Fig. 14 Persistent esophageal wall thickening in a 45-year-old man. He was complained of nausea, vomiting, epigastric soreness. There was no abnormal mucosal lesion on the repeat endoscopy. Serial axial images show circumferential wall thickening of esophagus (arrowheads), which is persistent on sequential CT obtained three years later. It is suggestive of the possibility of esophageal motility disorder.

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  Fig. 15 Omental fat herniation through the esophageal hiatus in a 58-year-old man. Serial axial images show herniated omental fat (*) in periesophageal area, and stomach herniation with hourglass appearance (arrow).

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