Читать книгу The Esophagus - Группа авторов - Страница 184

Leiomyomas are by far the most common benign submucosal tumors in the esophagus. Unlike gastrointestinal stromal tumors elsewhere, esophageal leiomyomas almost never undergo sarcomatous degeneration and, unlike gastrointestinal stromal tumors in the stomach, are almost never ulcerated [116]. Patients with esophageal leiomyomas are usually asymptomatic but occasionally may present with dysphagia, depending on the size of the tumor and how much it encroaches on the lumen.

When esophageal leiomyomas grow exophytically into the mediastinum, they can sometimes be recognized on chest radiographs by the presence of a mass in the right superior mediastinum, occasionally containing punctate calcifications [116]. Esophageal leiomyomas are usually manifested on esophagography by a smooth submucosal mass, etched in white, that forms right angles or slightly obtuse angles with the adjacent esophageal wall when viewed in profile [116] (Figure 6.60). These lesions therefore may be indistinguishable on barium studies from other mesenchymal tumors such as granular cell tumors, lipomas, hemangiomas, fibromas, and neurofibromas, except that leiomyomas are more likely on empirical grounds. Occasionally, computed tomography (CT) may be helpful for differentiating submucosal esophageal masses from extrinsic tumors or lymphadenopathy in the mediastinum compressing the esophagus.

Figure 6.49 Cytomegalovirus (CMV) esophagitis in an acquired immunodeficiency syndrome (AIDS) patient. Double‐contrast view shows a giant, flat ulcer (arrows) in the distal esophagus. Note the thin rim of edema abutting the ulcer. Because herpetic ulcers rarely become this large, the presence of one or more giant ulcers should be highly suggestive of CMV esophagitis in the appropriate clinical setting.

Source: Reproduced from Laufer I, Levine MS, eds. Double contrast gastrointestinal radiology, 2nd ed.Philadelphia: WB Saunders; 1992, with permission.