Читать книгу The Esophagus - Группа авторов - Страница 190

Esophageal diverticula may be classified as pulsion or traction diverticula. The more common pulsion diverticula result from esophageal dysmotility with increased intraluminal pressures in the esophagus, whereas traction diverticula are caused by scarring in the soft tissues surrounding the esophagus. Diverticula most commonly occur in the region of the pharyngoesophageal junction (i.e. Zenker’s diverticulum), mid esophagus, and distal esophagus above the GEJ (i.e. epiphrenic diverticulum). Other patients may develop tiny outpouchings from the esophagus, known as esophageal intramural pseudodiverticula.

Figure 6.62 Communicating esophageal duplication cyst. Single‐contrast view shows a branching, tubular outpouching (arrows) from the midesophagus. This is a rare type of esophageal duplication cyst.

Source: Reproduced from Levine [112], with permission.

Figure 6.63 Early esophageal carcinoma. Double‐contrast view shows a plaque‐like lesion (black arrows) in the mid esophagus with a flat central ulcer (white arrows).

Figure 6.64 Early adenocarcinoma in Barrett’s esophagus. Double‐contrast view shows a long peptic stricture in the distal esophagus above a hiatal hernia. Also note irregular flattening (arrows) of one wall of the stricture. Endoscopic and surgical biopsy specimens revealed an early adenocarcinoma arising in Barrett’s esophagus.

Source: Reproduced from Levine et al. [129], with permission.

Figure 6.65 Superficial spreading carcinoma. Double‐contrast view shows focal nodularity of the mucosa in the mid esophagus. Note how the nodules are poorly defined, producing a confluent area of disease. This appearance should be highly suspicious for a superficial spreading carcinoma.

Source: Reproduced from Levine MS. Radiology of the esophagus. Philadelphia: WB Saunders, 1989, with permission.

Figure 6.66 Infiltrating squamous cell carcinoma. Double‐contrast view shows an irregular area of narrowing in the mid esophagus with nodularity and ulceration of the narrowed segment. Also note the abrupt, shelf‐like margins of the lesion.

Figure 6.67 Polypoid squamous cell carcinoma. Double‐contrast view shows a polypoid mass (arrow) in the mid esophagus.

Figure 6.68 Primary ulcerative squamous cell carcinoma. Double‐contrast view shows a large meniscoid ulcer (arrows) surrounded by a thick rind of tumor in the distal esophagus.

Source: Reproduced from Levine MS. Radiology of the esophagus. Philadelphia: WB Saunders, 1989, with permission.

Figure 6.69 Infiltrating adenocarcinoma. Double‐contrast view shows an irregular area of narrowing in the distal esophagus. Note how the lesion extends into the proximal edge of a hiatal hernia. This patient had an adenocarcinoma arising in Barrett’s esophagus.

Source: Reproduced from Levine MS. Radiology of the esophagus. Philadelphia: WB Saunders, 1989, with permission.

Figure 6.70 Schatzki ring. (A) Double‐contrast view shows no evidence of a ring in the distal esophagus, but the region abutting the gastroesophageal junction is not optimally distended. (B) Prone single‐contrast view from the same examination shows a smooth, symmetric ring‐like constriction (arrow) at the gastroesophageal junction above a hiatal hernia. This Schatzki ring caused intermittent dysphagia for solids.