Читать книгу The Esophagus - Группа авторов - Страница 179

Whether accidental or intentional, ingestion of lye or other caustic agents can lead to a severe form of esophageal injury characterized by marked esophagitis and stricture formation. When esophagography is performed after a patient ingests a caustic agent, water‐soluble contrast media should be used because of the risk of esophageal perforation. Such studies may reveal marked edema, spasm, and ulceration of the affected esophagus, and in some cases, esophageal disruption [112]. As the esophagitis heals, follow‐up studies may reveal marked stricture formation, typically involving a long segment of the thoracic esophagus [112] (Figure 6.57). Patients with chronic lye strictures have an increased risk of developing squamous cell carcinoma of the esophagus [113], so a new area of mucosal irregularity or nodularity within a pre‐existing lye stricture on barium studies should raise concern about the possibility of a superimposed carcinoma.

Figure 6.44 Barrett’s esophagus with reticular pattern. Double‐contrast view shows the earliest stage of a stricture in the mid esophagus with slight flattening of one wall (white arrow). Also note a distinctive reticular pattern of the mucosa (black arrows) just below the level of the stricture. This radiographic finding is thought to be highly suggestive of Barrett’s esophagus.

Source: Reproduced from Levine et al. [83], with permission.