Radiologic Evaluation of Esophageal Diseases

Abstract

A barium swallow is an essential part of the workup of patients with esophageal disorders. This test defines the anatomy and is very useful for planning therapy. For instance, it is important preoperatively to distinguish a sliding from a paraesophageal hiatal hernia. In achalasia, it might also influence the decision for therapy depending on the size and shape of the esophagus. A CT scan and a PET scan are an essential part of the workup of patients with esophageal cancer to predict the response to neoadjuvant therapy. The goal of this chapter is to provide the reader with normal and pathologic reference images of the most common esophageal diseases and to illustrate how the radiologic evaluation is complementary, yet essential, for both the diagnosis and the surveillance of these disorders.

A barium swallow (Figs. 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 2.10, 2.11, 2.12, 2.13, 2.14, 2.15, 2.16, 2.17, 2.18, 2.19, 2.20, 2.21, 2.22, 2.23, 2.24, 2.25) is an essential part of the workup of patients with esophageal disorders. This test defines the anatomy and is very useful for planning therapy. A CT scan (Figs. 2.26 and 2.27) and a PET scan (Fig. 2.28) are an essential part of the workup of patients with esophageal cancer. The goal of this chapter is to provide the reader with normal and pathologic reference images of the most common esophageal diseases and to illustrate how the radiologic evaluation is complementary, yet essential, in diagnosis and surveillance.

Fig. 2.1

Normal barium swallow

Fig. 2.2

Barium swallow. Sliding hiatal hernia

Fig. 2.3

Barium swallow. Sliding hiatal hernia

Fig. 2.4

Barium swallow. Paraesophageal hernia

Fig. 2.5

Barium swallow. Paraesophageal hernia

Fig. 2.6

Chest and abdominal CT scan. Type IV hiatal hernia with stomach and colon above the diaphragm

Fig. 2.7

Barium swallow. Paraesophageal hernia with gastric volvulus

Fig. 2.8

Barium swallow. Paraesophageal hernia with gastric volvulus

Fig. 2.9

Barium swallow. Schatzki’s ring (arrows)

Fig. 2.10

Barium swallow. Schatzki’s ring (arrows)

Fig. 2.11

Barium swallow. Esophageal achalasia

Fig. 2.12

Barium swallow. End-stage achalasia with dilated and sigmoid esophagus

Fig. 2.13

Barium swallow. Diffuse esophageal spasm

Fig. 2.14

Barium swallow. Zenker’s diverticulum (arrows)

Fig. 2.15

Barium swallow. Zenker’s diverticulum (arrow)

Fig. 2.16

Barium swallow. Epiphrenic diverticulum

Fig. 2.17

Barium swallow. Epiphrenic diverticulum

Fig. 2.18

Barium swallow. Epiphrenic diverticula (arrows)

Fig. 2.19

Barium swallow. Esophageal fibrovascular polyp

Fig. 2.20

Endoscopy (left) with endoscopic ultrasound (right). Esophageal fibrovascular polyp

Fig. 2.21

Barium swallow. Esophageal leiomyoma

Fig. 2.22

Barium swallow. Esophageal leiomyoma

Fig. 2.23

Barium swallow. Distal esophageal adenocarcinoma

Fig. 2.24

Barium swallow. Distal esophageal adenocarcinoma

Fig. 2.25

Barium swallow. Midthoracic esophageal squamous cell cancer

Fig. 2.26

Endoscopy (left) and endoscopic ultrasound (right). Midthoracic esophageal squamous cell cancer

Fig. 2.27

Chest CT scan. Midthoracic esophageal squamous cell cancer (arrows)

Fig. 2.28

PET scan. Midthoracic esophageal squamous cell cancer (arrows)