Lymphatic metastases to the esophagus

The authors present 4 cases of esophageal involvement by lymphatic spread of tumors originating in the stomach, distal esophagus, and thyroid. Double-contrast radiographs of the esophagus showed discontinuous submucosal extension and multiple polypoid masses.     

Videofluoroscopy of the pharynx and esophagus in chronic graft-versus-host disease

Successful allogeneic bone marrow transplantation (BMT) for hematologic disorders may be complicated by graft-versus-host-disease (GVHD). Chronic GVHD is a systemic disease, involving, among other organs, the skin, mouth, liver, and esophagus. Esophageal involvement results in mucosal inflammation, leading to submucosal fibrosis and, occasionally, formation of webs and strictures. We investigated 25 allogeneic BMT recipients (17 with and eight without chronic GVHD). All patients had a videofluoroscopic study of the pharynx and esophagus to determine the radiographic abnormalities characteristic of chronic GVHD. Oropharyngeal abnormalities (poor bolus control, pharyngeal retention, or excessive mucous secretions) were found in five patients with and three patients without GVHD. Only one patient with GVHD had a pharyngo-esophageal stricture. There was no significant difference between the two groups with regard to pharyngo-esophageal radiographic abnormalities and esophageal symptoms. Radiographic evidence of esophageal motility disorder is not specific for GVHD involvement. In the absence of specific radiographic features, endoscopy is the most accurate method for the diagnosis of esophageal involvement by GVHD.This work was supported by the Ludwig Boltzmann Institute for Radiologic Tumor Diagnosis, Vienna, Austria.     

Glycogenic acanthosis of the esophagus: Radiographic and pathologic features

Diagnostic features of glycogenic acanthosis of the esophagus on air-contrast radiography, endoscopy, and histopathologic studies in 10 selected cases are presented.Glycogenic acanthosis of the esophagus is a common benign entity, characterized by multifocal plaques of hyperplastic squamous epithelium with abundant intracellular glycogen deposits. At esophagoscopy or on autopsy specimens these lesions appear as slightly raised grey-white plaques which are usually 2–10 mm in diameter and may be confluent. They cause a finely nodular or cobblestone mucosal pattern demonstrable on doublecontrast views of the well-distended eosphagus. The findings are not associated with mucosal ulcerations, luminal narrowing, or mobility disturbance, although some patients may have coexistent hiatal hernia and gastroesophageal reflux.     

Efficacy of radiology of the esophagus for evaluation of dysphagia

The efficacy of radiology in evaluating dysphagia was studied in 86 patients by comparison to endoscopic findings. In the 66 patients with endoscopic abnormalities radiology was correct in 54, for a sensitivity of 82%. Sensitivity of radiology improved to 95% if mild esophagitis was excluded. In the 20 patients with normal endoscopy, radiology was normal in 18 (90%). Thus radiology proved to be a reliable means of evaluating the esophagus in patients with dysphagia.     

食管腔内下咽起源巨大脂肪肉瘤1例

患者男,56岁。3年前出现进食哽咽感,6个月前症状加重并常伴胸骨后疼痛。本院食管造影示：食管全程巨大充盈缺损,边缘较光滑。钡剂位于肿瘤与食管壁之间、或在分叶状肿瘤表面呈瀑布样流过即显示为涂抹征。食管壁尚规则、柔软,未见明确黏膜破坏征象,钡剂通过无明显受阻,考虑为壁在性病变（图1）。     

Granular cell tumors of the esophagus

Three cases of granular cell tumor of the esophagus are added to the 17 previously reported in the literature. These tumors, thought to be of neural origin, are difficult to diagnose preoperatively. The diagnosis should be considered in adult females presenting with an intramural mass of the proximal or distal third of the esophagus. Symptoms of dysphagia and substernal discomfort are likely to occur with lesions greater than one centimeter in diameter. Preoperative biopsy is not advised as a mistaken diagnosis of squamous cell carcinoma can result.     

Mucocele of the surgically isolated esophagus

A large esophageal mucocele causing chest pain developed in a 26-year-old woman who had undergone esophageal bypass surgery and gastric interposition because of involvement by scleroderma. Computed tomographic (CT) scans showed the mucocele as an elongated mediastinal mass which spontaneously reduced in size during conservative management. The clinical and radiological features of this unusual postsurgical complication are herein reviewed.     

Posterior mediastinal teratoma involving the esophagus

Intrathoracic teratomas are difficult to diagnose on chest radiographs if they are noncalcified and located in an atypical site. We report an unusual case of posterior mediastinal teratoma that involved the esophageal wall. Features noted on computed tomography (CT) of the chest and barium examination of the esophagus are herein presented.     

Circumferential web of the upper esophagus

Two patients with circumferential webs of the upper esophagus are presented. Both patients had a long history of intermittent dysphagia, particularly with solid food. The clinical, endoscopic, and radiologic features of these webs are discussed.     

食管贲门癌术后吻合口瘘的治疗

目的 探讨食管贲门癌术后吻合口瘘的合理治疗方法。方法 回顾近年272例食管贲门癌术后发生的15例吻合口瘘临床诊治情况,结合献分析保守治疗或二次开胸手术治疗的合理方法与时机。结果 全组共发生吻合口瘘15例（发生率5.5%）。其中颈部吻合口瘘6例（6.5%）,胸部吻合口瘘9例（5.0%）。14例作积极保守治疗、成功13例,死亡1例（作二次开胸手术再瘘死亡）。瘘死亡率13.3%。结论 颈部瘘或胸部瘘估计瘘口较小,感染易控制,以积极的保守治疗为宜,可取得较理想的效果。     

Double-contrast examination of the esophagus

A simple technique for double-contrast esophagography is described. The technique involves successive swallows of an excellent coating barium mixture and water to create the double contrast effect. Clinical and radiologic situations in which double-contrast esophagography have proven helpful include: (a) the detection of small esophageal tumors; (b) delineation of the morphologic features of neoplastic and inflammatory disease; and (c) assessment of the total vertical extent of esophageal disease. Accurate and/or confident diagnosis is aided considerably with double-contrast esophagography.     

Radiologic manifestations of iatrogenic changes of the esophagus

The review of the roentgen manifestations of iatrogenic changes in the esophagus permits their grouping into two major categories of intentional and nonintentional alterations. In the first group, iatrogenic changes are encountered following reconstructive or other types of surgery, radiotherapy, and their respective complications. Nonintentional changes of the esophagus include injuries induced during diagnostic procedures, life-saving measures, and drug therapy. The knowledge of the spectra of possible iatrogenic alterations is important for accurate radiologic evaluation of the patients and the recognition of complications.     

Evaluation of the esophagus with a marshmallow bolus: Clarifying the cause of dysphagia

We reviewed the radiographic examinations of the esophagus and medical records in 117 patients (55 women and 62 men; mean age, 52 years) in which a marshmallow bolus was also given. A one-third to one-half piece of a standard marshmallow was used with a mean size of 23 mm (±4.5 mm SD) measured in vivo. In 62 patients with no intrinsic structural narrowing of the esophagus, impaction occurred in only seven (11%). Four of these patients had an esophageal motility disorder, and three had a previous Nissen fundoplication. The remaining 55 patients had lower esophageal mucosal rings (47) or peptic strictures (8). Marshmallow impaction was seen in 27 of 47 rings (57%) and was inversely related to ring size, and in six of eight strictures (75%). Also, impaction was related to the ratio of bolus size to ring caliber, and invariably occurred when this ratio was greater than 1.5. Dysphagia was the presenting complaint in 76 (65%) patients, but was found equally in those without intrinsic narrowing and in those with ring or stricture. However, dysphagia was reproduced by the marshmallow bolus only in patients with esophageal narrowing or abnormal motility.     

Radiologic diagnosis of Barrett's esophagus: Critical analysis of 65 cases

A recent increase in the number of Barrett's esophagis being diagnosed is probably directly related to a proportional increase in endoscopic biopsies of the esophagus and awareness of premalignant potential of Barrett's mucosa. While the endoscopist can detect Barrett's mucosa with fair degree of accuracy, the radiologic diagnosis of Barrett's esophagus still remains a diagnostic challenge despite several well established radiologic features. We reviewed 65 patients with pathologically proven Barrett's esophagus and found a wide spectrum of radiologic features. These include hiatus hernia in 49, gastroesophageal reflux in 38, strictures in 32, esophagitis in 20, and characteristic Barrett's ulcer in 12. In addition ascending or migrating strictures were found in 10, mucosal pattern simulating areae gastricae in 5, cricopharyngeal dysfunction in 4, and fixed spiral folds in 3 patients. This constellation of radiologic features, some of which have not been previously emphasized, should further assist radiologists in suggesting the diagnosis of Barrett's esophagus.     

Radiologic demonstration of multiple foci of malignancy in the esophagus

Three patients, each with two synchronous esophageal carcinomas demonstrated radiologically, are presented. The importance of complete esophageal evaluation in patients with one obvious tumor of the esophagus is emphasized. Assessment of the full extent of disease in such cases directly affects treatment planning.     

结核性脑膜炎神经体征转归的相关因素分析

目的：评价影响结核性脑膜炎神经功能缺失体征转归的临床因素。方法：对我院神经内科1998～2003年收治的45例入院时有神经功能缺失体征的结核性脑膜炎患者的临床、生化特征、治疗1a后的神经功能恢复情况进行观察研究。结果：45例患者中神经功能缺失体征完全或部分恢复22例（48．9％），加重或无变化者23例（51．1％）。加重或无变化病例中14例（31．1％）仍留有明显神经系统残疾，9例（20．0％）死亡。多因素统计结果显示，患者开始抗结核治疗时间与神经功能缺失体征转归密切相关（OR=1．843．P＜0．05），其他变量（性别、年龄、肺结核病史、脑积水、脑梗死、脑脊液自细胞数、脑脊液蛋白含量、激素应用等）的差异无显著性。结论：患者发病后开始抗痨治疗时间是影响本组患者神经功能缺失体征转归的重要因素．因此延误诊断和治疗仍是目前引起结核性脑膜炎神经系统残疾和死亡的重要原因。     

Hemangiomas of the esophagus

Two cases of hemangioma of the esophagus are reported. The literature, etiology, clinical and radiologic findings, and therapeutic approach are reviewed.     

食管癌术后并发吻合口瘘的预防护理

目的：探讨预防食管癌术后并发吻合口瘘的护理经验。方法：食管癌560例手术后发生吻合口瘘24例，回顾其治疗过程。结果：明确了食管癌术后并发吻合口瘘的5种原因，即缝合技术不佳，吻合口感染，吻合口张力过大，患全身营养状况差，以及精神、神经因素。总结了预防食管癌术后并发吻合口瘘的护理方法是减少感染因素，改善患的营养状况，减轻吻合口张力和解除患精神压力。结论：采取有效的护理措施，提高护理工作质量，可减少食管癌术后吻合口瘘的发生。     

Localized saccular dilatation of the esophagus: An unusual cause of dysphagia

Two young women who had undergone resection of an esophageal enteric cyst subsequently developed saccular dilatation of the esophagus. The abnormality was localized to the site of previous surgery and caused dysphagia in both patients.     

Hirsute esophagus: Clinical and roentgen features

Clinical and roentgen features of hirsute esophagus in 3 patients are described. Exuberant hair growth and masses of hair in the endopharyngoesophagus produced the classic clinical triad of progressive dysphagia, hair-spitting, and choking spells. This unique and rare complication of reconstructive surgery of the pharynx and esophagus is related to the skin flaps which are mobilized and rotated to reconstruct a skin tube endopharyngoesophagus and to restore anatomical continuity of the gastrointestinal tract.