Читать книгу The Esophagus - Группа авторов - Страница 189

Lower esophageal rings are a common finding on esophagography, but only a small percentage of patients are symptomatic. The term Schatzki ring should be reserved for lower esophageal rings in symptomatic patients who present with dysphagia. These rings almost always occur at the GEJ. Histologically, the superior surface of the ring is lined by stratified squamous epithelium and the inferior surface by columnar epithelium. The exact pathogenesis of Schatzki rings is uncertain, but some rings are thought to develop as a result of scarring from reflux esophagitis.

Figure 6.60 Leiomyoma. Double‐contrast view shows a submucosal mass (arrows) in the upper thoracic esophagus. Note how the lesion has a smooth surface and forms slightly obtuse angles with the adjacent esophageal wall. These features are characteristic of a submucosal mass.

Figure 6.61 Giant fibrovascular polyp. (A) Double‐contrast view shows a smooth, expansile, sausage‐shaped mass in the upper thoracic esophagus (arrow denotes tip of polyp). (B) Computed tomography (CT) scan also shows an expansile mass (arrow) in the esophagus, with a thin rim of contrast surrounding the lesion, confirming its intraluminal location. Also note the predominantly fat density of the polyp. This CT finding is characteristic of fibrovascular polyps containing abundant adipose tissue.

Source: Reproduced from Levine et al. [121], with permission.

Schatzki rings typically appear on barium studies as 2–3 mm high, symmetric, web‐like constrictions (usually <13 mm in diameter) at the GEJ above a hiatal hernia (Figure 6.70). The rings can be missed if the distal esophagus is not adequately distended at fluoroscopy (Figure 6.70A), so it is important to obtain prone views of the esophagus during continuous drinking of a low‐density barium suspension in order to visualize these structures (Figure 6.70B). Studies have shown that biphasic esophagography is a sensitive technique for the diagnosis of Schatzki rings, occasionally detecting rings that are missed on endoscopy [134].