Читать книгу The Esophagus - Группа авторов - Страница 185

Fibrovascular polyps are rare benign mesenchymal tumors characterized by the development of a pedunculated intraluminal mass that can grow to enormous sizes in the esophagus. These lesions consist histologically of varying amounts of fibrovascular and adipose tissue covered by normal squamous epithelium [119]. Fibrovascular polyps are almost always thought to arise near the level of the cricopharyngeus, gradually elongating over a period of years as they are dragged inferiorly by esophageal peristalsis [119]. Some of these polyps can become so large that they cause dysphagia or wheezing as a result of extrinsic compression of the trachea by the polyp. Rarely, these patients have a spectacular clinical presentation with regurgitation of a fleshy mass into the pharynx or mouth, or even asphyxia and sudden death if the regurgitated polyp occludes the larynx [120].

Figure 6.50 Human immunodeficiency virus (HIV) esophagitis in patients with acquired immunodeficiency syndrome (AIDS). (A) Double‐contrast view shows a large diamond‐shaped ulcer (black arrows) with a cluster of small satellite ulcers in the mid esophagus. The rounded filling defect (white arrow) proximally is an air bubble. (B) Double‐contrast view in another patient shows a large, flat ulcer (arrows) in profile in the distal esophagus. HIV ulcers are impossible to differentiate from cytomegalovirus ulcers on the basis of the radiographic findings, so endoscopy is required for a definitive diagnosis before treating these patients.

Source: Reproduced from Levine et al. [95], with permission.

Fibrovascular polyps usually appear on esophagography as smooth, expansile, sausage‐shaped masses that expand the lumen of the upper or mid esophagus [121] (Figure 6.61A). Occasionally, a discrete pedicle can be seen originating near the level of the cricopharyngeus. Fibrovascular polyps that contain a considerable amount of adipose tissue may appear as fat‐density lesions on CT (Figure 6.61B), whereas fibrovascular polyps that contain varying amounts of fibrovascular and adipose tissue may have a heterogeneous appearance with areas of fat juxtaposed with areas of soft tissue density [121]. Thus, fibrovascular polyps may be manifested by a spectrum of findings on CT, depending on their predominant histologic components.