Читать книгу The Esophagus - Группа авторов - Страница 193

Esophageal intramural pseudodiverticula consist pathologically of dilated excretory ducts of deep mucous glands in the esophagus. The pseudodiverticula typically appear on esophagography as flask‐shaped outpouchings in longitudinal rows parallel to the long axis of the esophagus [135] (Figure 6.73A). The pseudodiverticula classically have a diffuse distribution in the esophagus and are sometimes associated with strictures in the upper or mid esophagus [135]. However, it is more common to have an isolated cluster of pseudodiverticula in the distal esophagus in the region of a peptic stricture [135] (Figure 6.73B). In such cases, the pseudodiverticula most likely occur as a sequela of scarring from reflux esophagitis.

When viewed en face on double‐contrast esophagrams, esophageal intramural pseudodiverticula can sometimes be mistaken for tiny ulcers. When viewed in profile, however, they often appear to be “floating” or “levitating” outside the wall of the esophagus without any apparent communication with the lumen [135] (Figure 6.73B), whereas true esophageal ulcers are almost always seen to communicate directly with the lumen. This sign is extremely helpful for differentiating esophageal intramural pseudodiverticula from ulcers.

Figure 6.72 Traction diverticulum. Double‐contrast view shows a triangular outpouching (straight arrow) from the left lateral wall of the mid esophagus. Also note a clump of calcified lymph nodes (curved arrow) in the adjacent pulmonary hilum. This traction diverticulum presumably was caused by scarring from old tuberculous disease in the mediastinum.