Читать книгу The Esophagus - Группа авторов - Страница 173

Cytomegalovirus (CMV) is another cause of infectious esophagitis that occurs primarily in patients with AIDS or organ transplants or in those who are severely immunocompromised. CMV esophagitis may be manifested on double‐contrast studies by the development of one or more giant, flat ulcers that are several centimeters or more in length [94] (Figure 6.49). The ulcers may have an ovoid or diamond‐shaped configuration and are often surrounded by a thin radiolucent rim of edema. Because herpetic ulcers rarely become this large, the presence of one or more giant ulcers should suggest the possibility of CMV esophagitis in the appropriate clinical setting. However, the differential diagnosis also includes giant human immunodeficiency virus (HIV) ulcers in the esophagus (see next section). Less commonly, CMV esophagitis may be manifested by small, superficial ulcers indistinguishable from those in herpes esophagitis [94]. Because CMV esophagitis is treated with relatively potent antiviral agents such as ganciclovir, which has associated bone marrow toxicity, endoscopy (with biopsy specimens, brushings, or cultures from the esophagus) is required to confirm the presence of CMV infection before treating these patients.