Читать книгу The Esophagus - Группа авторов - Страница 178

A radiation dose of 5000 cGy or more to the mediastinum may cause severe injury to the esophagus. Acute radiation esophagitis usually occurs two to four weeks after the initiation of radiation therapy [110]. This condition may be manifested by ulceration or by a granular appearance of the mucosa and decreased distensibility resulting from edema and inflammation of the irradiated segment [110] (Figure 6.56A). The extent of disease conforms to the margins of the radiation portal. Most cases of acute radiation esophagitis are self‐limited, but some patients may have progressive dysphagia due to the development of radiation strictures four to eight months after completion of radiation therapy [111]. These strictures typically appear as smooth, tapered areas of concentric narrowing within a pre‐existing radiation portal (Figure 6.56B). Fistula formation is another uncommon complication of chronic radiation injury to the esophagus.

Figure 6.43 Barrett’s esophagus with mid‐esophageal stricture. Prone single‐contrast view shows a large hiatal hernia (straight arrow) and a moderately long stricture (curved arrow) in the mid esophagus a considerable distance from the hernia. In the proper clinical setting, the presence of a mid‐esophageal stricture should be highly suggestive of Barrett’s esophagus, but this finding is seen on barium studies in only a small percentage of patients with this condition.