Acute alcoholic esophagitis

We report two patients with acute, transient esophagitis following alcoholic binges. Double-contrast esophagrams of both patients revealed erosive esophagitis with multiple superficial ulcers in the mid and distal esophagus. While acute alcoholic esophagitis may produce clinical and radiographic findings that are indistinguishable from other more common types of esophagitis, this diagnosis is supported by the patients' recent drinking history.     

Pseudomembranes in reflux esophagitis

Three cases are presented in which double-contrast esophagograms revealed one or more plaquelike lesions in the distal esophagus, representing pseudomembrane formation in patients with severe reflux esophagitis. Although to our knowledge this finding has not been reported previously in the radiologic literature, pseudomembranes have been documented endoscopically in patients with reflux esophagitis and biopsy-proved Barrett esophagus. Radiologists should be aware of this finding, since these pseudomembranes may be indistinguishable radiographically from plaquelike carcinomas arising in Barrett esophagus.     

CT findings in patients with esophagitis

OBJECTIVE: The purpose of our study was to determine the CT findings in patients with esophagitis. MATERIALS AND METHODS: A search of medical and radiology files revealed 29 patients with esophagitis in whom thoracic CT was performed within 1 month of the diagnosis. The CT scans were reviewed retrospectively for esophageal wall thickening, a target sign, or other abnormalities. The thickness of the esophageal wall was also measured on CT in these 29 patients and compared with a control group of 85 patients. RESULTS: We found that 16 patients (55%) with esophagitis had abnormal findings on CT, including a thickened esophageal wall (using 5 mm as the threshold for wall thickening) in all 16 (55%) and a target sign in five (17%). The overall mean esophageal wall thickness was 4.7 mm (standard deviation [SD], 2 mm; 95% confidence interval [CI], 0.7-8.7 mm) in patients with esophagitis versus a mean wall thickness of 2.9 mm (SD, 0.8 mm; 95% CI, 1.3-4.5 mm) in controls (p <.001). Using the same 5-mm threshold for wall thickening, we found that only three (4%) of 85 controls had a thickened esophageal wall on CT. CONCLUSION: The majority of patients with esophagitis had abnormalities on CT, including a thickened esophageal wall (> or =5 mm) in 55% and a target sign in 17%. Although barium studies and endoscopy are more sensitive modalities for detecting this condition, the CT finding of a relatively long segment of circumferential esophageal wall thickening, with or without a target sign, should suggest the diagnosis of esophagitis in the proper clinical setting.     

Drug-induced esophagitis detected by double-contrast radiography

Patients with esophageal symptoms following drug ingestion underwent double-contrast upper gastrointestinal studies, and radiographic findings are described. Superficial esophageal ulceration and subtle mucosal abnormalities, which have not been seen on single-contrast radiographs, were confirmed on double-contrast radiographs. Erosions or ulcers usually occur in the region of the aortic arch and occasionally lower in the esophagus. Repeat esophagrams after withdrawal of the medication indicate resolution of the symptoms.     

Gallium-67 imaging in candidal esophagitis

Ga-67 scanning has been used to evaluate esophageal carcinoma. It has demonstrated candidal infection in other body sites and, in one previous case, in the esophagus. The authors present a case of diffuse esophageal uptake of Ga-67 in esophageal candidiasis.     

Acid corrosive esophagitis: radiographic findings

Thirty-nine esophagograms of 24 patients after ingestion of muriatic acid (27% HCI) in suicide attempts were reviewed. All esophagograms were obtained in the acute, subacute, and chronic phases. In the acute and subacute phases, the radiographic findings consisted of mucosal edema, submucosal edema or hemorrhage, ulcerations, sloughing of the mucosa, atony, and dilatation. Strictures of the esophagus were present in the chronic phase. These radiographic findings were not different from those found in alkaline corrosive esophagitis. The severity of the corrosive esophagitis is considered related to the concentration, amount, viscosity, and duration of contact between the caustic agent and the esophageal mucosa.     

Radiographic findings in herpetic esophagitis.

The authors report a case of classic esophagitis simulating candidiasis radiographically. Endoscopy provided pathological conformation of herpes infection, showing typical multinucleated cells with intranuclear inclusion bodies.     

Opportunistic esophagitis caused by Aspergillus fumigatus

The authors report on a 59-year-old man with opportunistic esophagitis caused by Aspergillus fumigatus. Although the patient had no underlying disease, esophagitis occurred after a short course of antibiotic therapy. A double contrast esophagogram showed multiple nodular or vertical plaque-like projections. Endoscopy provided pathological conformation of Aspergillus infection.     

Single- and double-contrast techniques in esophagitis

The relative efficacy of double- and single-contrast radiographs of the esophagus in the detection of esophagitis was compared with findings at esophagoscopy in 52 patients. The addition of double-contrast views to the examination increased the number of radiographic abnormalities seen and led to the radiographic detection of esophagitis in four patients in whom the diagnosis would otherwise have been missed. The use of double-contrast views did not lead to significant improvement in the overall accuracy, however, since their use was associated with an increase in the false-positive interpretation rate. Superficial mucosal irregularity, ulcers, and narrowing were the most specific radiographic abnormalities and all were detected more frequently on double-contrast views.