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Shintaku M. Esophageal intramural pseudodiverticulosis. World J Gastroenterol 2024; 30:137-145. [PMID: 38312118 PMCID: PMC10835521 DOI: 10.3748/wjg.v30.i2.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/21/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
Esophageal intramural pseudodiverticulosis (EIPD) is a disease of unknown pathogenesis characterized by usually systemic, cystic dilatation of the excretory ducts of esophageal submucosal glands. In this article, I review the epidemiology, clinical manifestations, endoscopic findings, esophagographic findings, and histopathology of EIPD. I also discuss the etiology and possible pathogenesis of EIPD based on my experiences with this disease and a review of the literature. EIPD usually presents with dysphagia in middle-aged individuals. It is often complicated with secondary infections, most commonly candidiasis. On esophagography, EIPD is delineated as small, multiple, flask-shaped outward projections within the esophageal wall. In recent years, EIPD has been mainly diagnosed by endoscopic findings of multiple, localized, small mucosal depressions. The orifices of the "pseudodiverticula" periodically open and close, and excrete mucus onto the mucosal surface. On histopathological examination, the luminal surface of dilated ducts in EIPD is covered by multilayered, hyperplastic epithelial cells, but myoepithelial cells in the glandular acini are well preserved. Treatment of EIPD is usually symptomatic therapy, and prevention of the infectious complications is important. The etiology and pathogenesis of EIPD are largely unknown, but functional abnormalities of autonomic nerve fibers innervating the esophageal glands likely play an important role, since the structures of the glands are basically preserved in this disease.
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Affiliation(s)
- Masako Shintaku
- Department of Gastroenterology, Japan Community Healthcare Organization Hoshigaoka Medical Center, Hirakata 573-8511, Osaka, Japan
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Feng C, Li L, Zhang Y, Zhao Y, Huang J. Diagnosis and management of congenital type D esophageal atresia. Pediatr Surg Int 2023; 39:280. [PMID: 37815659 PMCID: PMC10564804 DOI: 10.1007/s00383-023-05519-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 10/11/2023]
Abstract
This study was performed to describe the current clinical practice and outcomes of type D esophageal atresia. We retrospectively analyzed 10 patients who were diagnosed with type D esophageal atresia and underwent esophageal atresia and tracheoesophageal fistula repair in the Capital Institute of Pediatrics and Beijing Children's Hospital from January 2017 to May 2022. Ten patients include three newborns and seven non-newborns. Seven (70%) cases were misdiagnosed as type C esophageal atresia before the first operation. Three neonatal children underwent thoracoscopic distal tracheoesophageal fistula ligation and esophageal anastomosis: the proximal tracheoesophageal fistula was simultaneously repaired with thoracoscopy in one of these children, and the proximal tracheoesophageal fistula was not detected under thoracoscopy in the other two children. Among the seven non-neonatal children, one underwent repair of the proximal tracheoesophageal fistula through the chest and the other six underwent repair through the neck. Nine patients were cured, and one died of complications of severe congenital heart disease. Type D esophageal atresia lacks specific clinical manifestations. Misdiagnosis as type C esophageal atresia is the main cause of an unplanned reoperation. Patients without severe malformations have a good prognosis.
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Affiliation(s)
- Cuizhu Feng
- Department of Pediatric Surgery, Capital Institution of Pediatrics, Beijing, People's Republic of China
- Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment, Chinese Academy of Medical Sciences 2021RU015, Beijing, China
| | - Long Li
- Department of Pediatric Surgery, Capital Institution of Pediatrics, Beijing, People's Republic of China
| | - Yanxia Zhang
- Department of Pediatric Surgery, Capital Institution of Pediatrics, Beijing, People's Republic of China
| | - Yong Zhao
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center of Children's Health, Beijing, People's Republic of China
| | - Jinshi Huang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center of Children's Health, Beijing, People's Republic of China.
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Kim SH. Congenital esophageal stenosis caused by tracheobronchial remnants: A case report. Radiol Case Rep 2023; 18:3672-3674. [PMID: 37601120 PMCID: PMC10432260 DOI: 10.1016/j.radcr.2023.07.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/18/2023] [Accepted: 07/23/2023] [Indexed: 08/22/2023] Open
Abstract
Congenital esophageal stenosis caused by tracheobronchial remnants is a rare anomaly in infants and children that results in dysphagia and recurrent pneumonia. An accurate diagnosis is needed because this anomaly does not respond well to instrumental dilatation, such as bougienage and balloon dilatation, and requires surgical resection. Herein, I report a case of congenital esophageal stenosis caused by tracheobronchial remnants with characteristic imaging findings.
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Affiliation(s)
- Soung Hee Kim
- Department of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea
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Frankel L, Ardeljan AD, Santizo G, Guerra M, Gharat G, Alnajar S, Manjani D, Ardeljan A, Takabe K, Rashid OM. Esophageal Perforation in a 76-Year-Old Man After C5-C7 Anterior Discectomy and Anterior Plate Fusion. World J Oncol 2023; 14:158-163. [PMID: 37188039 PMCID: PMC10181427 DOI: 10.14740/wjon1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/06/2023] [Indexed: 05/17/2023] Open
Abstract
Anterior cervical discectomy and fusion (ACDF) is indicated for the treatment of various cervical pathologies, including myelopathy, cervical disc degeneration, and radiculopathy. Esophageal perforation is a rare postsurgical complication of ACDF, although it poses serious and potentially fatal outcomes. Esophageal perforation has been described as the most fatal complication of the gastrointestinal tract as delayed diagnosis can lead to sepsis and death. Diagnosis of this complication is often difficult because it can be masked by various symptoms such as recurrent aspiration pneumonia, fever, dysphagia, and neck pain. While this complication usually occurs within the first 24 h post-surgery, it can also develop later and persist chronically in rare cases. Awareness and early recognition of this complication may improve outcomes and reduce mortality and morbidity. A 76-year-old man underwent C5-C7 ACDF in October 2017. A thorough review of the patient's postoperative condition included computed tomography (CT) and esophagogram, which were negative for signs of acute complications. The postoperative recovery was uneventful until several months post-procedure when he began to develop vague dysphagia and weight loss of unknown etiology. A CT scan was obtained 6 months postoperatively and was negative for perforation. He then underwent a battery of inconclusive procedures and scans at multiple institutions. After several months of persistent dysphagia and weight loss without a diagnosis, the patient presented to our network for further workup and treatment recommendations. Upper endoscopy was performed and showed fistulization between the esophagus and the metal hardware in the cervical spine. Esophagram demonstrated no obstruction but decreased peristalsis of the lower esophagus and lateral rightward deviation of the left upper cervical esophagus with minimal mucosal irregularities. These findings were secondary to mass effect of the cervical plate. The patient was successfully treated with a surgical approach using esophagogastroduodenoscopy (EGD) guided repair in layers and a sternocleidomastoid muscle flap. This report demonstrates a rare case of delayed esophageal perforation after ACDF and successful treatment of the perforation by surgical repair using the dual technique.
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Affiliation(s)
- Lexi Frankel
- Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | - Amalia D. Ardeljan
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Gabriela Santizo
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Maximiliano Guerra
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Ghargi Gharat
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Sarmed Alnajar
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Divesh Manjani
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Andrew Ardeljan
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, the State University of New York, Buffalo, NY, USA
| | - Omar M. Rashid
- Nova Southeastern University, Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
- Department of Surgery, Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA
- University of Miami, Leonard Miami School of Medicine, Miami, FL, USA
- Department of Surgical Oncology, Massachusetts General Hospital, Boston, MA, USA
- Department of Surgical Oncology, Broward Health, Fort Lauderdale, FL, USA
- TopLine MD Alliance, Fort Lauderdale, FL, USA
- Department of Surgical Oncology Memorial Health, Pembroke Pines, FL, USA
- Department of Surgical Oncology, Delray Medical Center, Delray, FL, USA
- Corresponding Author: Omar M. Rashid, Complex General Surgical Oncology, General & Robotic Surgery, TopLine MD Alliance, Fort Lauderdale, FL 33308, USA.
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Lee SB, Choi YH, Kim SH, Cho YJ, Lee S, Cheon JE. Factors influencing outcomes of esophageal balloon dilatation for anastomosis site stenosis after esophageal atresia surgery. Pediatr Radiol 2023; 53:349-57. [PMID: 36216986 DOI: 10.1007/s00247-022-05523-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/05/2022] [Accepted: 09/22/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Esophageal balloon dilatation is an effective treatment for anastomotic strictures, but the factors affecting the outcome of dilatation remain unclear. OBJECTIVE To investigate the predictive factors of esophageal balloon dilatation outcome in children with anastomotic stricture after esophageal atresia repair. MATERIALS AND METHODS We retrospectively reviewed children with esophageal atresia who underwent esophageal balloon dilatation for postoperative strictures between August 2007 and February 2021. We investigated each child's age, weight and height; type of esophageal atresia surgery; shape, length and level of stricture; esophageal balloon dilatation balloon size; application of mitomycin; number of inflation sessions; and number of esophageal balloon dilatation sessions. The outcome of each esophageal balloon dilatation session was determined as improvement in stricture diameter between pre- and post-esophageal balloon dilatation esophagography. We used uni- and multivariate analyses with generalized estimating equations to evaluate outcome predictors. RESULTS Overall, 69 children (mean age, 2.3 years; 45 boys) underwent 227 esophageal balloon dilatations. In the univariate analysis, the positive effect of esophageal balloon dilatation decreased with increased age, weight, height, balloon size and number of esophageal balloon dilatation sessions. Additionally, the positive effect was decreased in cervical-level strictures and with the application of mitomycin during esophageal balloon dilatation. In the multivariate analysis, independent prognostic factors of the positive esophageal balloon dilatation effect were age (incidence rate ratio [IRR]: -0.01; 95% confidence interval [CI]: -0.01, -0.002), shape of stricture (IRR: -0.54; 95% CI: -0.91, -0.18) and number of esophageal balloon dilatation sessions (IRR, -0.10; 95% CI: -0.14, -0.18). CONCLUSION Repeated esophageal balloon dilatation, older age and eccentric stricture shape are associated with poor response to esophageal balloon dilatation in children with anastomotic strictures after esophageal atresia repair.
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Wang NK, Molin NL, Soliman AMS. Postoperative management of Zenker's diverticulum: Results of the American Bronchoesophagological Association survey. Am J Otolaryngol 2022; 43:103602. [PMID: 35981430 DOI: 10.1016/j.amjoto.2022.103602] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Although treatment of Zenker's diverticulum (ZD) is commonly performed by otolaryngologists using a variety of surgical techniques, there is little published data on the postoperative management of patients. We sought to determine practice patterns among members of the American Bronchoesophagological Association (ABEA) after surgery for ZD. METHODS An online questionnaire was designed via JotForm™ and subsequently sent to active members of the ABEA. Responses were analyzed using descriptive statistics. RESULTS Twenty-three members (6.6 %) completed the survey. Most (73.9 %) were fellowship trained in laryngology and reported performing >5 procedures per year. Most laryngologists reported employing multiple techniques including transcervical (TC) (73.9 %), endoscopic stapling (ES) (65.2 %), endoscopic CO2 laser (EL) (56.5 %), and endoscopic harmonic scalpel (EH) (4.3 %). Postoperatively, 52.3 % of respondents placed patients in 23-hour observation after TC, 66.7 % after ES, 69.2 % after EL, and 100 % after EH. 47.1 % of respondents used standard overnight admission after TC, as compared to 13.3 % after ES, 23.1 % after EL and 0 % after EH. Postoperative esophagography was utilized by 70.6 % of respondents after TC, 20 % after ES, 38.5 % after EL, and 100 % after EH. A peroral diet was started postoperatively on the day of surgery by 26.7 % respondents after ES but not after any of the other techniques. CONCLUSION Most laryngology trained respondents employ multiple techniques for the treatment of ZD including at least 1 endoscopic technique. Respondents were more likely to hospitalize patients after a transcervical than endoscopic approach. Postoperative esophagography was utilized in most patients after TC, but not after ES or EL. Most respondents admit patients for 23-hour observation and start a peroral diet on postoperative day 1 regardless of technique.
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Affiliation(s)
- Nigel K Wang
- Department of Otolaryngology-Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Nicole L Molin
- Department of Otolaryngology-Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America
| | - Ahmed M S Soliman
- Department of Otolaryngology-Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States of America.
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Chen SY, Toh HS, Chang WT, Liao CT. A Rare Cause of Left Atrium Compression. Int Heart J 2021; 62:944-948. [PMID: 34234073 DOI: 10.1536/ihj.20-734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Extrinsic compression of the left atrium (LA) due to esophageal achalasia has been considered a rare occurrence. Patients might present with dysphagia, dyspnea, and even hemodynamic compromise simultaneously. Prompt detection with a thorough differential diagnosis is crucial for subsequent management. In this case report, we present a patient with LA compression by esophageal achalasia and performed a literature review to gather information as regards the clinical manifestation, diagnosis, and treatment strategy of this rare disease.A 59-year-old man with intermittent palpitation, heartburn sensation, and difficulty swallowing came to our emergency department due to acute onset of chest compression and breathlessness after a large meal. As per his chest X-ray, dilated mediastinum and small gastric bubble were noted. Electrocardiogram implied left atrial enlargement, and the Holter monitor reported one episode of paroxysmal atrial fibrillation attack during his meal. Transthoracic echocardiogram showed a round-shaped, well-bordered, hyperechogenic, and heterogeneous mass compressing the LA irrespective of the systolic or diastolic phase. A chest contrast-enhanced computed tomography scan was then performed, wherein it showed diffuse esophageal dilatation with a smoothly thickening wall aligned compressing the LA. Meanwhile, the barium swallow esophagogram revealed contrast pooling at the esophagogastric junction with a bird beak shape. Accordingly, extrinsic compression of LA by esophageal achalasia was diagnosed.Esophageal achalasia compressing LA has been considered rare. Remarkably, given that a patient is presenting with dysphagia and concurrent chest tightness, palpitation, and dyspnea after swallowing food, the clinicians should keep this diagnosis in mind. Careful history review to clarify the causal relationship between the symptoms, specific findings on electrocardiogram and chest X-ray, and utilization of echocardiography and esophagography are beneficial for a prompt and accurate diagnosis.
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Affiliation(s)
- Sih-Yao Chen
- Department of Internal Medicine, Chi-Mei Medical Center
| | - Han Siong Toh
- Department of Intensive Care Medicine, Chi Mei Medical Center.,Institute of Clinical Medicine, National Cheng Kung University
| | - Wei-Ting Chang
- Institute of Clinical Medicine, National Cheng Kung University.,Division of Cardiovascular Medicine, Department of Internal Medicine, Chi-Mei Medical Center.,Department of Biotechnology, Southern Taiwan University of Science and Technology
| | - Chia-Te Liao
- Division of Cardiovascular Medicine, Department of Internal Medicine, Chi-Mei Medical Center.,Department of Public Health, College of Medicine, National Cheng Kung University.,Department of Electrical Engineer, Southern Taiwan University of Science and Technology
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Serrano L, Saad AR, DuCoin C, Jacobs JW, Richter JE, Velanovich V. Discordance between high-resolution manometry, esophagoscopy and contrast esophagogram in determining landmarks for per-oral endoscopic myotomy in spastic esophageal disorders: a word of caution. Surg Endosc 2021; 35:5613-9. [PMID: 33048228 DOI: 10.1007/s00464-020-08064-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Myotomy length for per-oral endoscopic myotomy (POEM) is standardized for type I and II achalasia. However, for type III achalasia, jackhammer esophagus, diffuse esophageal spasms and esophagogastric junction outflow obstruction, there is no standard. Determining myotomy length based on the high-pressure zone found during high-resolution manometry (HRM) and spastic length found during esophagography may be used to determine adequate myotomy length without excess muscle destruction. METHODS The records of patients who have undergone POEM procedures at our institution had the following data gleaned: age, sex, esophageal spastic diagnosis, length of high-pressure zone and lower esophageal sphincter (LES) position by HRM, length of spastic esophagus by esophagography, position of the z-line by esophagoscopy and length of myotomy performed. Outcomes were assessed based on patient symptomatic improvement and need for re-intervention. RESULTS 71 patients were evaluated for POEM, with 67 completing POEM. There was an average difference in LES position by HRM and z-line position by esophagoscopy of 3.9 ± 3.0 cm. There was an average difference in high-pressure zone by HRM and spastic length by esophagography of 4.9 ± 3.2 cm. Overall, with a median of 20 months follow-up, 74% achieved long-term symptomatic improvement, with 17 patients requiring re-intervention. CONCLUSIONS Discordance among HRM, esophagography and esophagoscopy can be significant. Caution should be employed with using these methods to determine myotomy length in POEM.
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Terrazas M, Marjon L, Geter M, Schwartz J, Thompson W. Esophagography and chest CT for detection of perforated esophagus: what factors influence accuracy? Abdom Radiol (NY) 2020; 45:2980-2988. [PMID: 31435763 DOI: 10.1007/s00261-019-02187-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine: whether the use of both esophagography (EG) and CT is superior to either study alone in the detection of esophageal injuries and perforations. METHODS Paired CT and EG performed for suspected perforated or injured native esophagus (NAE) or neo-esophagus (NEOE) were retrospectively identified and independently scored for likelihood of perforation with a Likert scale. Official reports were scored with the same scale. Retrospective study and official interpretations were assessed separately for overall diagnostic accuracy, for diagnosis of contained versus free perforation. RESULTS 110 paired exams performed in 107 patients fulfilled inclusion criteria. Overall, combined CT and EG retrospective study interpretation was greater than EG or CT scans alone. Study EG and combined CT and EG interpretations were less sensitive for contained perforations than for free perforations. Evaluations of NAE and NEOE showed similar sensitivities. Receiver operating characteristic (ROC) curve generated from combined official CT and EG interpretations was superior to ROC from combined retrospective study interpretations. CONCLUSIONS Combination of EG and CT can improve sensitivity for detecting perforated intrathoracic viscus, but even with combined studies accurate diagnosis of contained perforations is challenging. Superior performance of official reports suggests that concurrent review using both modalities may improve accuracy.
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Affiliation(s)
- Martha Terrazas
- Department of Radiology, University of New Mexico HSC, MSC10 5530, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Lauren Marjon
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Matthew Geter
- Department of Radiology, University of New Mexico HSC, MSC10 5530, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Jess Schwartz
- Department of Surgery, University of New Mexico HSC, MSC10 5530, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - William Thompson
- Department of Radiology, University of New Mexico HSC, MSC10 5530, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
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Abstract
Corrosive (caustic) material ingestion remains a major health issue, particularly in developing countries. The management strategy after corrosive ingestion should be planned according to the signs and symptoms. The management of corrosive ingestion based on endoscopic grading, nothing by mouth, and barium studies should be abandoned. With the new management protocol, esophageal stricture can be predicted with high accuracy using the simple new prognostic DROOL score (≤ 4) rather than endoscopic grading, reduced by immediate oral feeding as soon as the patient can swallow saliva instead of nothing by mouth, diagnosed earlier (10-14 days) by fluoro-endoscopic balloon-assisted esophageal examination for patients with persistent dysphagia instead of relying on a barium study (≥ 21 days), and adequately treated by initiating balloon dilation earlier during the same anesthesia procedure. Fluoroscopically guided balloon dilatation with large balloons (18-20 mm) seems to be safe, with a low frequency of complications and a high success rate. If dilatation fails after a few months, esophagectomy and replacement surgery using the stomach should be considered. The increased risk of developing esophageal carcinoma after ingestion of corrosive substances should be kept in mind.
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Affiliation(s)
- Ibrahim Uygun
- Department of Pediatric Surgery, Faculty of Medicine, Kutahya Health Sciences University, Evliya Celebi Training and Research Hospital, Merkez, 43040, Kutahya, Turkey.
| | - Salih Bayram
- Clinic of Pediatric Surgery, Artvin Government Hospital, Artvin, Turkey
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Fuhrmann C, Weissenborn M, Salman S. Mediastinal fluid as a predictor for esophageal perforation as the cause of pneumomediastinum. Emerg Radiol 2021; 28:233-8. [PMID: 32813157 DOI: 10.1007/s10140-020-01841-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/12/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Pneumomediastinum is not an uncommon finding on emergency CTs and is seen in a variety of settings, including acute trauma, recent repeated emesis and recent thoracic surgery, and after EGD (Kouritas et al. J Thorac Dis 7(Suppl 1):S44-S49, 2015). The purpose of this study was to examine cases of CT pneumomediastinum for distinguishing features which could support or exclude esophageal injury as a cause, which in turn could help guide evaluation of these patients. METHODS CT chest scans showing pneumomediastinum performed in the emergency department between January 2013 and December 2018 were included. The presence or absence of fluid within the mediastinal compartments was correlated with esophageal perforation and subdivided into the clinical scenarios of trauma, suspected Boerhaave's syndrome, recent surgery or EGD, and other. Accuracy of this finding was compared with fluoroscopic esophagography. RESULTS Twenty-two cases of esophageal perforation were identified out of a total of 324 included cases. The cases were subdivided into four categories: trauma, suspected Boerhaave syndrome, suspected iatrogenic perforation from recent procedure or surgery, and other. Two hundred fourteen cases of pneumomediastinum occurred in the setting of trauma, and 2 had esophageal perforation. Both showed mediastinal fluid. Twenty-two cases had mediastinal fluid without perforation. Seventeen cases of pneumomediastinum occurred in the setting of suspected Boerhaaves, and 3 had esophageal perforation. Every case with esophageal perforation had mediastinal fluid, and every case without perforation had no mediastinal fluid. Nine cases of pneumomediastinum occurred in the setting of suspected iatrogenic perforation after recent surgery or procedure. Six cases had esophageal perforation, and 5 of these had mediastinal fluid. All three cases without perforation also had mediastinal fluid. Eighty-six cases were classified as other and included a variety of clinical histories. This category contained 8 esophageal perforations, 7 of which had mediastinal fluid. One case of mediastinal fluid was not associated with esophageal perforation in this category. CONCLUSION The presence of mediastinal fluid, specifically within the visceral compartment, strongly suggests esophageal injury, and its absence strongly argues against it. An important caveat is in the setting of recent surgery, in which mediastinal fluid can be seen normally. An esophagography study can supplement the evaluation if there is a discrepancy between the clinical suspicion and the original CT findings.
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Yamasaki T, Tomita T, Mori S, Takimoto M, Tamura A, Hara K, Kondo T, Kono T, Tozawa K, Ohda Y, Oshima T, Fukui H, Watari J, Miwa H. Esophagography in Patients With Esophageal Achalasia Diagnosed With High-resolution Esophageal Manometry. J Neurogastroenterol Motil 2018; 24:403-409. [PMID: 29969858 PMCID: PMC6034667 DOI: 10.5056/jnm17147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/27/2018] [Accepted: 05/21/2018] [Indexed: 01/01/2023] Open
Abstract
Background/Aims High-resolution esophageal manometry (HREM) is considered to be the gold standard for the diagnosis of achalasia. However, the Japan Esophageal Society recommends that esophagography is also accurate in either diagnosing or excluding the disorder. Accordingly, we compared the efficacy of esophagography and HREM in diagnosing achalasia patients with upper gastrointestinal symptoms. Methods HREM was performed in 126 patients with dysphagia. The final diagnosis of achalasia was done using HREM. Demographic data, symptoms, quality of life (QOL) were also obtained. We assessed the patients who were not able to be diagnosed by esophagography and compared the diagnostic values for esophagography with HREM-based achalasia diagnosis as the gold standard. Results A total of 48 cases of patients with achalasia, including 21 men and 27 women (mean age, 48.4 ± 19.6 years), were included in the study. Two patients were excluded. Of the remaining 46 patients, 36 (78.3%) patients were diagnosed as having achalasia by esophagography. The diagnostic sensitivity, specificity, and accuracy of esophagography were 78.3%, 88.0%, and 83.0%, respectively. Patients with type III achalasia had significantly lower physical QOL score than those with type I or II achalasia. Although the mental QOL score in patients with type III achalasia tended to decrease compared with that in patients with type I and II achalasia, the difference was not statistically significant. Conclusions Diagnosing esophageal achalasia by using esophagography alone has limited yield. Therefore, HREM should be used in patients with dysphagia and in whom achalasia cannot be diagnosed using EGD or esophagography.
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Affiliation(s)
- Takahisa Yamasaki
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toshihiko Tomita
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Sumire Mori
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Mayu Takimoto
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Akio Tamura
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Ken Hara
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takashi Kondo
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tomoaki Kono
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Katsuyuki Tozawa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yoshio Ohda
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tadayuki Oshima
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hirokazu Fukui
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Jiro Watari
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroto Miwa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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13
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Abstract
Although endoscopy is a sophisticated technique for evaluating patients with gastroesophageal reflux disease (GERD), the single diagnostic test that enables the most comprehensive assessment for GERD is a well-performed video esophagram. Not only does the barium study permit assessment of morphologic abnormalities in the pharynx and esophagus, but also oropharyngeal swallowing function, esophageal motility, and gastroesophageal reflux. These factors are especially important for detection of anatomic findings such as strictures and hernias, for assessment of esophageal motility before and after fundoplication, and for excluding conditions that mimic GERD. Thus, esophagography and esophagoscopy are complementary procedures that provide a more comprehensive and therapeutically actionable plan for patients with GERD than either diagnostic test alone.
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14
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Awais M, Qamar S, Rehman A, Baloch NUA, Shafqat G. Accuracy of CT chest without oral contrast for ruling out esophageal perforation using fluoroscopic esophagography as reference standard: a retrospective study. Eur J Trauma Emerg Surg 2018; 45:517-525. [PMID: 29484462 DOI: 10.1007/s00068-018-0929-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/23/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Esophageal perforation has a high mortality rate. Fluoroscopic esophagography (FE) is the procedure of choice for diagnosing esophageal perforation. However, FE can be difficult to perform in seriously ill patients. METHODS We retrospectively reviewed charts and scans of all patients who had undergone thoracic CT (TCT) without oral contrast and FE for suspicion of esophageal perforation at our hospital between October, 2010 and December, 2015. Scans were interpreted by a single consultant radiologist having > 5 years of relevant experience. Statistical analysis was performed using SPSS version 20. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TCT were computed using FE as reference standard. RESULTS Of 122 subjects, 106 (83%) were male and their median age was 42 [inter-quartile range (IQR) 29-53] years. Esophageal perforation was evident on FE in 15 (8%) cases. Sensitivity, specificity, PPV and NPV of TCT for detecting esophageal perforation were 100, 54.6, 23.4 and 100%, respectively. When TCT was negative (n = 107), an alternative diagnosis was evident in 65 cases. CONCLUSION Thoracic computed tomography (TCT) had 100% sensitivity and negative predictive value for excluding esophageal perforation. FE may be omitted in patients who have no evidence of mediastinal collection, pneumomediastinum or esophageal wall defect on TCT. However, in the presence of any of these features, FE is still necessary to confirm or exclude the presence of an esophageal perforation.
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Affiliation(s)
- Muhammad Awais
- Department of Radiology, The Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan. .,Department of Radiology, Dow University of Health Sciences, Ojha Campus, Suparco Road, KDA Scheme 33, Karachi, Sindh, 75270, Pakistan.
| | - Saqib Qamar
- Department of Radiology, The Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan
| | - Abdul Rehman
- Department of Radiology, The Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan.,Internal Medicine Section, Department of Medicine, Hamad Medical Corporation, P.O. box 3050, Doha, Qatar
| | - Noor Ul-Ain Baloch
- Department of Radiology, The Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan.,Department of Medicine, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Gulnaz Shafqat
- Department of Radiology, The Aga Khan University Hospital, P.O. box 3500, Stadium Road, Karachi, Sindh, 74800, Pakistan
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15
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Pan J, Zou Y, Li L, Yang TY, Yang JL, Hu C. Clinical and imaging differences between neonates and children with pyriform sinus fistula: which is preferred for diagnosis, computed tomography, or barium esophagography? J Pediatr Surg 2017; 52:1878-1881. [PMID: 28886900 DOI: 10.1016/j.jpedsurg.2017.08.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 07/16/2017] [Accepted: 08/07/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Pyriform sinus fistula (PSF) is very rare. It is difficult to make an accurate diagnosis preoperatively. The aim of this study is to summarize the characteristics of clinical and radiologic presentations in neonates and children with PSF and to assess which examination is more helpful for diagnosis. METHODS A retrospective review was performed in 29 patients with PSF at a single center from January 2013 to September 2016. The clinical presentation, computed tomography (CT) scan/magnetic resonance imaging (MRI), and barium esophagogram were evaluated between neonates and children. RESULTS This study comprised 14 neonates and 15 children. Neonatal patients presented with cervical cyst, dyspnea, and stridor. However, the most common presentations of children were recurrent neck abscess and thyroiditis. All the neonates and 12 the children underwent CT scan/MRI, which showed the characteristic air pocket in the cervical lesion of 11 (78.6%) neonates and 4 (33.3%) children. The positive rates of barium esophagography in the neonates and children were 27.3% and 86.7%, respectively, the difference of which was statistically significant. CONCLUSION To obtain an accurate diagnosis of PSF, the differences in clinical and radiologic presentation suggest that CT scan/MRI is preferred for neonates, and barium esophagography is preferred for children. CT scans performed immediately after barium swallow improve the positive rate.
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Affiliation(s)
- Jing Pan
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Affiliated Women and Children's Medical Center of Guangzhou Medical University, Guangzhou, China
| | - Yan Zou
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Affiliated Women and Children's Medical Center of Guangzhou Medical University, Guangzhou, China.
| | - Le Li
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Affiliated Women and Children's Medical Center of Guangzhou Medical University, Guangzhou, China
| | - Tian-You Yang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Affiliated Women and Children's Medical Center of Guangzhou Medical University, Guangzhou, China
| | - Ji-Liang Yang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Affiliated Women and Children's Medical Center of Guangzhou Medical University, Guangzhou, China
| | - Chao Hu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Affiliated Women and Children's Medical Center of Guangzhou Medical University, Guangzhou, China
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16
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Abstract
The esophagus may be involved by a variety of morphologic abnormalities, including nodules and plaques, ulceration, distal esophageal strictures and rings, upper or midesophageal strictures, and diffuse narrowing (also known as a small-caliber esophagus). The use of a pattern approach for evaluating esophageal disease on barium studies facilitates diagnosis of a host of pathologic conditions associated with these morphologic abnormalities. This article therefore presents an approach for diagnosing esophageal disease on barium studies that emphasizes the radiographic and clinical features used to differentiate the underlying causes of disease and the diagnostic pitfalls associated with performing and interpreting these studies.
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17
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Krishnan P, Kartikueyan R, Patel SM, Bose PP, Mukherjee KK. Two Cases of Esophageal Injury Following Anterior Cervical Discectomy and Fusion: One Overt and One Covert. Ann Neurosci 2017; 24:126-130. [PMID: 28588368 DOI: 10.1159/000475902] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/06/2016] [Indexed: 01/30/2023] Open
Abstract
Esophageal perforation is a dreaded complication of anterior cervical spinal surgery. A 52-year-old diabetic man had undergone a surgery for a C6-C7 disc prolapse and developed spiking fever with chills and rigor on the 7th postoperative day. No cause could be found out but a CT scan of thorax done in the course of investigations revealed pneumomediastimum. The patient succumbed on the 10th day after surgery. Autopsy revealed the cause of death to be mediastinitis following iatrogenic esophageal perforation. A second patient, 53 years of age, following surgery for C5-C6 disc prolapse and developed intractable dysphagia. Later, fever and purulent discharge from the wound prompted an MRI showing prevertebral collection extending to the superior mediastinum. Presuming only wound infection, debridement and implant removal was done. However persistent serous discharge from the wound revealed an esophageal injury. Late diagnosis precluded primary repair. With conservative treatment, the fistula finally closed after 42 days. Postoperative dysphagia, a common complaint following surgery, may not always be present in cases of esophageal injury. A high index of suspicion is required for diagnosing and initiating treatment for esophageal perforation before complications set in.
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Affiliation(s)
- Prasad Krishnan
- Department of Neurosurgery, National Neurosciences Centre, Kolkata, India
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18
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Abstract
Barium esophagography, although an old test, remains important to the understanding of esophageal physiology and diagnosis of esophageal disorders. It provides additive and/or confirmatory information to endoscopy and is the more accurate means of yielding diagnosis. Barium esophagography allows correlation of symptoms with barium findings and with varied textures substances. It allows, particularly for oropharyngeal dysfunction, implementation therapeutic maneuvers and instructions while testing. The caveat to maintaining the benefits of barium esophagography is continuing to promote and support expertise from our radiologists in performing these studies, which has been challenged by our cost-efficient and high-tech medical society.
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Affiliation(s)
- David A Katzka
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Avenue Southwest, Rochester, MN 55905, USA.
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19
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Abstract
AIM: To study the clinical characteristics, diagnosis and surgical treatment of congenital bronchoesophageal fistulae in adults.
METHODS: Eleven adult cases of congenital bronchoesophageal fistula diagnosed and treated in our hospital between May 1990 and August 2010 were reviewed. Its clinical presentations, diagnostic methods, anatomic type, treatment, and follow-up were recorded.
RESULTS: Of the chief clinical presentations, nonspecific cough and sputum were found in 10 (90.9%), recurrent bouts of cough after drinking liquid food in 6 (54.6%), hemoptysis in 6 (54.6%), low fever in 4 (36.4%), and chest pain in 3 (27.3%) of the 11 cases, respectively. The duration of symptoms before diagnosis ranged 5-36.5 years. The diagnosis of congenital bronchoesophageal fistulae was established in 9 patients by barium esophagography, in 1 patient by esophagoscopy and in 1 patient by bronchoscopy, respectively. The congenital bronchoesophageal fistulae communicated with a segmental bronchus, a main bronchus, and an intermediate bronchus in 8, 2 and 1 patients, respectively. The treatment of congenital bronchoesophageal fistulae involved excision of the fistula in 10 patients or division and suturing in 1 patient. The associated lung lesion was removed in all patients. No long-term sequelae were found during the postoperative follow-up except in 1 patient with bronchial fistula who accepted reoperation before recovery.
CONCLUSION: Congenital bronchoesophageal fistula is rare in adults. Its most useful diagnostic method is esophagography. It must be treated surgically as soon as the diagnosis is established.
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20
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Ghimire P, Wu GY, Zhu L. Primary esophageal lymphoma in immunocompetent patients: Two case reports and literature review. World J Radiol 2010; 2:334-8. [PMID: 21160688 PMCID: PMC2999330 DOI: 10.4329/wjr.v2.i8.334] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 05/27/2010] [Accepted: 06/04/2010] [Indexed: 02/06/2023] Open
Abstract
Primary lymphoma that involves the esophagus is very rare, with fewer than 30 cases reported in the English-language literature. Non-Hodgkin lymphoma accounts for most of the cases. Esophageal lymphomas have varied radiological appearances, which poses diagnostic difficulty. We report two cases of histopathologically confirmed primary diffuse large B-cell esophageal lymphoma and describe their radiological features, and briefly review the literature.
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21
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Abstract
Tracheoesophageal fistula (TEF) or bronchoesophageal fistula may be congenital, inflammatory, neoplastic, or secondary to trauma. Congenital TEF or bron-choesophageal fistula is usually associated with eso-phageal atresia and is readily diagnosed in infancy. But if it is not associated with esophageal atresia, it may persist until adulthood. Some theories have been proposed to explain this delay in diagnosis. We present a case of a 70-year-old man with congenital TEF. The TEF was successfully diagnosed by multidetector-row CT esophagography.
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Affiliation(s)
- Koichi Nagata
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Yokohama 224-8503, Japan.
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