Читать книгу The Esophagus - Группа авторов - Страница 169

As esophageal ulcers heal, localized scarring may be manifested on barium studies by flattening, puckering, or sacculation of the adjacent esophageal wall, often associated with the development of radiating folds [73] (Figure 6.40).

Further scarring can lead to the development of circumferential strictures (also known as “peptic” strictures) in the distal esophagus, almost always above a hiatal hernia [73, 78] (Figure 6.41). These strictures often appear as concentric areas of smooth, tapered narrowing, but asymmetric scarring can lead to asymmetric narrowing with focal sacculation or ballooning of the esophageal wall between areas of fibrosis. When there is marked irregularity, flattening, or nodularity of one or more walls of the stricture, endoscopy and biopsy should be performed to rule out a malignant stricture as the cause of these findings.

Figure 6.25 Retention cyst in medial left hypopharynx. A smooth‐surfaced hemispheric line (arrow) protrudes into the left piriform sinus.

Source: Reproduced from Rubesin and Glick [23], with permission.

Figure 6.26 Polypoid squamous cell carcinoma of the base of the tongue. (A) Frontal view of the pharynx demonstrates that the barium pool in the left vallecula is replaced by a 1.5 cm nodular mass (arrows) with barium in its interstices. (B) Lateral view of the pharynx shows a 1.5 cm radiolucent filling defect (black arrows) in the barium pooling in the valleculae. Barium has entered the interstices of the tumor (white arrows) deep to the expected contour of the base of the tongue.

Source: Reproduced from Rubesin and Glick [23], with permission.

Scarring from reflux esophagitis can also lead to longitudinal shortening of the esophagus and the development of fixed transverse folds, producing a characteristic “stepladder ” appearance caused by pooling of barium between the folds [79] (Figure 6.40). These fixed transverse folds should be differentiated on barium studies from the thin transverse folds (also known as the “feline” esophagus) often seen in patients with gastroesophageal reflux as a transient finding resulting from contraction of the longitudinally oriented muscularis mucosae [80, 81] (Figure 6.42).