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Esophagus

Anatomy: glosso-epiglotic fold, valeculae, pyriform sinuses Esophageal indentations: higher is aortic arch, lower is left mainstem bronchus Epiphrenic diverticulum: outpouching from the anterior wall of the lower esophagus Esophageal atresia: pouch filling with contrast, Tracheo-Esophageal fistula (distal bowel gas) Mallory-Weiss tear: defect in mucosal surface, discontinuation of the contrast lining, extravasation of contrast, ulcer; Boerhave is perforation Fundoplication: filling defect of contrast at GE junction, surg.clips Feline esophagus: numerous small folds - contraction of superficial layer muscularis mucosae; ch.irritation from GERD, normal in cats Achalasia: beak sign just proximal to GE junction, constriction, Chagas disease (Trypanozoma cruisi) Surgical Gastric pull-through: stomach high in the chest (diff. from hiatal hernia) Diffuse esophageal spasm: abnormal corkscrew appearance, shishkabab esophagus; primary and secondary ctx are nl, abnl tertiary contractions: if painful = diffuse esophageal spasm, if non-painful = Presbyesophagus in older pt Aberant right subclavian artery: CT through the aortic arch, b/l pleural effusion, esophagus compressed by aberant right subclavian artery, dysphagia Lusoria (joke of nature) Esophageal cancer: filling defect in the lumen Foreign body in esophagus: soft tissue lateral neck, foreign body and calcified laryngeal cartilage Schatzke’s ring: mucosal web at the GE junction in the setting of small hiatal hernia, 12mm Esophageal Varices: axial CT through the level of liver, thickened wall of esophagus w/ arterial enhancement = varices (tumors in this location are hypovascular), nodular surface of the liver = cirrhosis Retropharyngeal abscess: prevertebral soft tissue is thickened - gas in the soft tissue from perforation, pharynx is narrow Zenker’s diverticulum: contrast collection in the outpouching from the posterior wall of the proximal esophagus, aspiration in the laryngeal ventricle Dobhoff tube displacement: in the pleural space through the R bronchus intermedius, expect pneumothorax w/ tube withdrawal Candidial esophagitis: multiple filling defects HIatal hernia: Foreign body w/ perforation: fish in throat, gas in the retropharyngeal soft tissue Esophageal intramural pseudodiverticulosis: multiple barium collections protruding through the esophageal wall, dilated mucosal glands from irritation - GERD Esophago-Tracheal fistula: partial filling of esophagus w/ malignant fistula into trachea and contrast into the bronchial tree Varices: 2 images 5 sec apart, change in vascular channels Inpacted food: filling defect in the lower esophagus, intraluminal mass - undigested food, could be neoplastic Duplication esophageal cyst: fluid filled cystic lesion in posterior mediastinum HU (-5 to 5) Esophageal perforation: contrast extravasation beyond the lumen of the esophagus-surgery Esophageal cancer: diffuse esophageal wall thickening Diverticula: Zenkers larger, posterior, Killian-Jamieson smaller lateral; epiphrenic Scleroderma: Reflux esophagitis: look for hiatal hernia, strictures, webb, ulcerations, tumor, surgical changes Schatzki ring in the setting of hiatal hernia above GE junction, symptomatic <12mm (13mm pill) Webb Infectious espohagitis: candida (carpeting, bubbles), herpetic, drug induced, caustic (chemical) esophagitis, radiation Intramural pseudodivericulosis; CH. IRRITATION, Trauma: - Mallory-Weiss tear by retching - mucosal tear (like aortal) - perforation - Boerhave sy Masses: - esophageal ca: irregular, shoulders, fistula to the lung and other - bng: leiomyoma, glycogenic acanthosis fibrovascular polyp duplication cysts: fluid containing structues varices: tubular structures on fluoro, CT Fundoplication: filling defect, lump created by surgeon, Gastric pullthrough: esophagectomy, [hiatal hernia] Colonic interposition: after esophagectomy Myotomy foreign body (bone), thyroid cartilage Retropharyngeal abscess - stricture of esophagus by retropharyngeal mass