Esophagus

Normal Esophageal Anatomy

  • Normal esophageal width = 3 mm

  • Upper 1/3 = striated muscle

  • Middle 1/3 = mixed striated and smooth muscle

  • Lower 1/3 = smooth muscle

  • Extends from cricopharyngeus muscles to the stomach

Malignant Esophageal Masses

  • Malignant masses can easily invade local structures due to lack of serosal covering of the esophagus

  • Look for —> Esophageal wall thickening + Intraluminal mass + Lumen narrowing

  • Squamous cell carcinoma (75%)

  • Adenocarcinoma (25%)

    • Secondary to Barrett’s esophagus and malignant transformation of dysplastic tissue

Benign Esophageal Masses

  • Well circumscribed mass

  • These are the only esophageal masses that can have calcifications (more so leiomyoma than GIST)

  • Leiomyoma

    • Tend to be large (>5 cm)

    • Not FDG-avid

  • GIST

    • FDG-avid

  • Papilloma

    • Most common benign lesion

Esophageal Diverticula

Feline Esophagus

  • Associated with reflux esophagitis

  • Folds are only in lower 2/3 of esophagus

  • Folds are transient and go away with swallowing

Esophageal Pseudodiverticulosis

  • Basically dilated excretory mucosal ducts

  • Look lie a bunch of squiggly lines along the borders of the esophagus

  • Associated with

    • esophageal structures - 90%

    • Reflux

    • Candidiasis

Candida esophagus

  • Seen in

    • Immunocompromised (GHIV, transplant)

    • Motility disorders (scleroderma, achalasia)

  • Presents as plaque like lesions, may be shaggy if severe

Herpes

  • Small and multiple ulcers with halo of edema

Zenker Diverticulum

  • Posterior

  • Just above cricopharyngeus muscle

  • In the hypopharynx

  • Area of weakness is the Killian triangle (but not a killin diverticula, nonsense I know)

Killian-Jamieson Diverticula

  • Anterolateral wall of cervical esophagus

  • Below cricopharyngeus muscle

  • Usually smaller and obv anterior compared to zenker

  • Rarest form of esophageal diverticula

Classic Esophagram Lesions

Esophageal Non-neoplastic lesions

Traction Diverticula

  • Seen at mid-esophagus

  • Said to be triangular, looks round to me

  • Occur secondary to scarring (prior granulomatous disease)

Epiphrenic Diverticula

  • Basically just above the GE junction at the diaphragm, hence “phrenic”

    • Typically on the RIGHT

      • Note, para-esophageal is typically on left

  • Look

Esophageal Web

  • Most common in cervical esophagus

  • Increased risk of esophageal and hypopharyngeal cancer

  • Plummer-Vinson

    • Iron deficiency anemia

    • Dysphagia/Esophageal web

    • Thyroid issues

    • Spoon shaped nails

Glycogenic Acanthosis

  • Basically focal collections of glycogen

  • Presents basically the same as Candida but

    • Seen in old people who are otherwise normal (not immunocompromised)

    • Asymptomatic

Esophageal Ulcers

CMV & HIV

  • Large and flat ovoid ulcers

Crohns

  • Rare unless severe disease

  • Look for description as Aphthous with prominent surrounding edema

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