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Keshav N, Khalid S, Parasher G, Cassidy F, Thompson W, Shiehmorteza M. Dots, lines, contours, and ends: An image-based review of esophageal pathology. Eur J Radiol Open 2021; 8:100361. [PMID: 34141830 PMCID: PMC8187835 DOI: 10.1016/j.ejro.2021.100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 05/29/2021] [Indexed: 11/25/2022] Open
Abstract
Learning Point #1: Small ulcers on esophagography are usually attributable to herpes esophagitis and drug-induced esophagitis. Although rare, Crohn’s disease may produce small apthoid ulcers. Large ulcers are usually attributable to CMV or HIV esophagitis. Learning Point #2: The early findings of candida are plaques that mimic glycogenic acanthosis. When plaques are seen, consider early candida or glycogenic acanthosis. When shaggy esophagus is identified, consider candidiasis. Learning Point #3: Varices and varicoid esophageal carcinoma may appear similar on imaging. The presence of obstruction and lack of change with time and position should sway the Radiologist to diagnosing varicoid esophageal carcinoma. Learning Point #4: Transverse esophageal lines should suggest the entities of feline esophagus and idiopathic eosinophilic esophagitis. Learning Point #5: Esophageal contour abnormalities may suggest extrinsic or intrinsic lesions. Extrinsic lesions include aberrant vessels. Intrinsic lesions include intramural pseudodiverticulosis, gastroesophageal reflux, Barrett’s esophagus, and esophageal cancer.
Esophageal pathologies encountered on fluoroscopic examination may pose a diagnostic challenge to the interpreting Radiologist. Understanding the varied imaging appearances of esophageal pathology requires a thorough understanding of barium esophagography. This article reviews the various fluoroscopic imaging findings of different esophageal pathologies by describing an approach to image interpretation centered on dots, lines, contours, and ends. By utilizing this approach, the Radiologist will be better positioned to reconcile seemingly disparate pathologies into a cogent and succinct differential diagnosis.
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Affiliation(s)
- Nandan Keshav
- University of New Mexico Health Sciences Center, Department of Diagnostic Radiology, MSC10 5530, 1 University of New Mexico, Albuquerque, NM, 87131, United States
| | - Sameen Khalid
- University of New Mexico Health Sciences Center, Division of Gastroenterology, Department of Internal Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, United States
| | - Gulshan Parasher
- University of New Mexico Health Sciences Center, Division of Gastroenterology, Department of Internal Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, United States
| | - Fiona Cassidy
- University of California San Diego School of Medicine, Department of Radiology, 8929 University Center Ln #101, San Diego, CA, 92122, United States
| | - William Thompson
- University of New Mexico Health Sciences Center, Department of Diagnostic Radiology, MSC10 5530, 1 University of New Mexico, Albuquerque, NM, 87131, United States
| | - Masoud Shiehmorteza
- University of New Mexico Health Sciences Center, Department of Diagnostic Radiology, MSC10 5530, 1 University of New Mexico, Albuquerque, NM, 87131, United States
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