Esophageal-Conditions-A-Radiological-Perspective.pptx

Barium Esophagogram notes

1. Esophageal Conditions: A Radiological Perspective This comprehensive list outlines the radiological findings associated with various esophageal conditions, as observed through barium esophagograms. From mild esophagitis to complex structural abnormalities, these diagnostic insights can aid clinicians in accurately identifying and managing a wide range of esophageal disorders. Na by Nagasai Pelala

2. Inflammatory Conditions Mild Esophagitis Characterized by fold thickening, this condition represents the mildest form of esophageal inflammation. The barium esophagogram may reveal subtle changes in the esophageal mucosal pattern, indicating the presence of this condition. Moderate Esophagitis Superficial erosions, appearing as lines and punctate defects, are the hallmark of moderate esophagitis on the barium esophagogram. These findings indicate a more advanced stage of esophageal inflammation. Severe Esophagitis In severe esophagitis, the barium esophagogram may reveal a few short and fixed transverse folds, reflecting the more significant mucosal damage and scarring associated with this condition.

3. Anatomical Variations 1 Feline Folds (Physiologic) These numerous, fine, delicate, symmetric, and transient folds are a normal anatomical variant and do not indicate any underlying pathology. 2 Chronic Reflux Induced Strictures Chronic gastroesophageal reflux can lead to the development of short segment strictures above the gastroesophageal junction, often accompanied by a short type esophageal hernia. 3 Intramural Esophageal Pseudodiverticulosis Diffuse tiny outpouchings, most commonly due to chronic reflux esophagitis, can be observed on the barium esophagogram.

4. Metaplastic and Neoplastic Conditions Barrett's Esophagus This condition is characterized by a mid-esophagus stricture, often accompanied by a hiatal hernia and possible reticular changes, as seen on the barium esophagogram. These findings are indicative of the metaplastic changes associated with Barrett's esophagus. Medication-Induced Esophagitis Certain medications can cause esophageal irritation and inflammation, leading to the formation of strictures at anatomical narrowings, as observed on the barium esophagogram. Eosinophilic Esophagitis Luminal narrowing and furrowing in the upper esophagus are characteristic radiological findings associated with eosinophilic esophagitis, a condition driven by an eosinophilic immune response.

5. Infectious and Inflammatory Conditions Candidiasis Multiple plaque-like filling defects on the barium esophagogram are indicative of esophageal candidiasis, a fungal infection that can occur in immunocompromised individuals. Herpes Esophagitis The barium esophagogram may reveal multiple discrete ulcerations on an otherwise normal esophageal mucosal background, characteristic of herpes esophagitis. Cytomegalovirus (CMV) Infection A large solitary discrete ulcer, especially in HIV-positive patients, is a typical radiological finding associated with CMV esophagitis.

6. Motility Disorders Achalasia The barium esophagogram in achalasia typically shows a dilated esophagus with a standing column of contrast and a beak-like stricture near the gastroesophageal junction, reflecting the impaired esophageal motility and incomplete relaxation of the lower esophageal sphincter. Pseudoachalasia / Carcinoma In cases of pseudoachalasia or esophageal carcinoma, the barium esophagogram may reveal a fixed rigid stricture with a soft tissue mass evident on CT, distinguishing it from the classic achalasia findings. Diffuse Esophageal Spasm (DES) The characteristic corkscrew appearance on the barium esophagogram is a hallmark of diffuse esophageal spasm, a motility disorder characterized by uncoordinated, non-peristaltic contractions of the esophageal smooth muscle.

7. Structural Abnormalities Leiomyoma A submucosal, circumscribed mass with a smooth impression on the esophageal contour is characteristic of an esophageal leiomyoma, a benign smooth muscle tumor. Esophageal Varices Serpentine filling defects with a scalloped contour in the distal esophagus are indicative of esophageal varices, dilated veins that can develop due to portal hypertension. Zenker's Diverticulum A diverticulum in the posterior wall of the cervical esophagus, known as a Zenker's diverticulum, can be visualized on the barium esophagogram.

8. Miscellaneous Conditions Caustic Strictures Long segment narrowing with dysmotility, irregular margins, edema, and plaques of sloughing mucosa. Glycogenic Acanthosis Nodular filling defect resembling reticular changes. Foreign Bodies Hard objects typically lodged in the upper esophagus. Meat Impaction Commonly found at the gastroesophageal junction.