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CT Findings of Esophageal disease

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Mi Sook Lee, Soo yeon Jeong, Soo yeon Kim

Department of Radiology, Presbyterian Medical Center, Jeonju, South Korea

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Introduction

  • Endoscopic evaluation has traditionally been the method of choice for diagnosing esophageal disease.

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  • However, thoracic CT is widely used for evaluating thoracic organ diseases and can provide valuable information about esophageal conditions, including their disease extent and relationship with adjacent organs.

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  • This study aims to present thoracic CT findings of various esophageal diseases, including submucosal lesions, fistulas, and perforations, which are often challenging to diagnose with endoscopy alone.

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Contents

1. Esophageal SET (Lipoma)

2. Esophageal polyp: Fibrovascular polyp

3. Esophageal GIST

4. Esophageal Diverticulum

5. Esophageal foreign body perforation into pleural space

6. Esophageal spontaneous perforation (Boerhaave’s disease)

7. Esophageal cancer: small cell carcinoma

8. Esophageal cancer: squamous carcinoma

9. Esophageal cancer: with lung fistula, abscess

10. Acid ingestion: esophagitis

11. Achalasia

12. Esophageal varix

13. Aortoesophageal fistula

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Case. 1 Subespithelial tumor: lipoma

  • M/63
  • For evaluation of subepithelial mass suspected on endoscopy

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Case. 1 Subespithelial tumor: lipoma

  1. Mediastinal window setting axial view of thorax at carina level. There is fatty mass posterior to edophagus.
  2. Mediastinal window setting coronal view of thorax. Elongated fatty mass in medial wall of esophagus

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A B

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Case. 2 Fibrovascular polyp

  • F/84
  • Incidental finding

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Case. 2 Fibrovascular polyp

A: Precontrast, B: postcontrast enhanced CT of thorax.

Esophageal polyp is composed of fatty tissue and vascular component.

A B

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Case. 3 Esophageal GIST

  • M/54
  • For evaluation of esophageal SET found on outside UGIS

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Case. 3 Esophageal GIST

A: Axial, B: sagittal image of thorax.

Homogeneous soft tissue mass involving lower esophageal wall.

A B

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Case 4. Esophageal diverticulum

  • M/60
  • For evaluation of distal esophageal diverticum referred from local clinic

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Case 4. Esophageal diverticulum

A: Axial, B: Coronal images of thorax.

Bilateral esophageal diverticuli visible.

A B

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Case 5. Esophageal foreign body perforation into Rt. Pleual space

  • M/76
  • C/C: Dyspnea, Rt. Chest wall pain

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Case 5. Esophageal foreign body perforation into Rt. Pleual space

A. Axial, B. Coronal imaging of thorax.

Radiopaque foreign body (chicken bone) at distal esophagus, and esophageal perforation into Rt. Pleural space.

A B

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Case 6. Esophageal spontaneous perforation: Boerhaave’ disease

  • M/53
  • C/C: chest pain

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Case 6. Esophageal spontaneous perforation: Boerhaave’ disease

  1. Initial CPA show hydropneumothorax in Lt. and pneumomediastinum
  2. Axial lung setting view of lower chest reveals pneumomediastinum around lower esophagus and pericardium, and Lt hydropneumothorax.

A B

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Case 7. Esophageal cancer: small cell carcinoma

  • M/84
  • C/C: palpable Rt neck mass

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Case 7. Esophageal cancer: small cell carcinoma

Contrast enhanced axial images of thorax. A : bilateral lower neck lymph node enlargement, B ~ D : large esophageal mass.

The patient did not complain dysphagia even though large esophageal mass.

The mass confirmed to small cell carcinoma.

A B

C D

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Case 7. Esophageal cancer: small cell carcinoma

  • E. Contrast enhanced saggital image of thotax show esophageal mass posterior to trachea.

E

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Case 8. Esophageal cancer: squamous cell carcinoma

  • M/67
  • C/C esophageal cancer evaluation

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Case 8. Esophageal cancer: squamous cell carcinoma

  • Contrast enhanced axial view of thorax demonstrates esophageal luminal narrowing caused by esophageal mass.
  • Endoscopic biopsy result in squamous cell carcinoma.

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Case 9. Esophageal cancer fistula with lung and abscess formation

  • M/52
  • C/C: cough, URI symptom

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Case 9. Esophageal cancer fistula with lung and abscess formation

A. Initial CPA shows RUL consolidation.

A

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Case 9. Esophageal cancer fistula with lung and abscess formation

Noncontrast enhanced axial images of thorax.

B. We can see esophageal wall thickening of esophageal cancer and RUL consolidation.

C. There is fistulous track(arrow) from esophagus to lung.

B C

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Case 10. Acid ingestion: esophagitis

  • F/88
  • C/C: R/O esophagitis on outside image

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Case 10. Acid ingestion: esophagitis

  • Postcontrast axial(A) & sagittal(B) view of thorax demonstrate diffuse edematous esophageal wall thickening.
  • Patient has history of acid ingestion.

A B

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Case 11. Achalasia

  • M/62
  • C/C: Achalasia evaluation

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Case 11. Achalasia

  1. Contrast enhanced axial view of mid thorax shows esophageal dilatation.
  2. Contrast enhanced axial view of lower thorax shows esophageal wall thickening.

A B

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Case 12. Esophageal varix

  • M/56
  • C/C: Liver cirrhosis evaluation

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Case 12. Esophageal varix

  1. Contrast enhanced axial view of lower thorax reveals esophageal & paraesophageal varix.

B. Contrast enhanced coronal view of lower chest & abdomem shows distal esophageal varix and dilatation of splenorenal shunt

A B

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Case 13. Aortoesophageal fistula

  • F/80
  • Hematemesis, bleeding evaluation

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Case 13. Aaortoesophageal fistula

  1. Nonenhanced axial view of upper thorax reveals esophagus(*) & trachea deviation to Rt. And hyperdense material in esophageal lumen.
  2. Postenhanced axial view of upper thorax demonstrates hyperdense esophageal lumen (*) same as aorta and fistula tract (arrow)

A B

*

*

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Thank you for your attention!