Ahalazija
The barium swallow in achalasia is characteristic. The oesophagus is dilated
and contrast material passes slowly into the stomach as the sphincter opens
intermittently. The distal oesophagus has a narrow segment and the image
resembles a bird's beak. This is in contrast to the rat's tail appearance of
carcinoma of the oesophagus. In the early stages, radiology can be normal.
Ahalazija
Strana tela u jednjaku
Najcesca su kod dece sitan novac dugmad I sl.
Konstrikcije jednjaka nastale dejstvom kausticnih materija
Approximately 5,000-15,000 cases of
caustic congestion occur in the US
every year.
About 50%-80% occur in the pediatric
population.
On the left a high stricture (arrow)
following caustic ingestion
Striktura jednjaka nakon radioterapije
Divertikuloza jednjaka
On the left a patient with a Zenker's
diverticulum as a result of premature
closure of the cricopharyngeal muscle.
Sliding hernia
On the left initially, GE junction is below the esophageal hiatus.
Later, stomach protrudes through hiatus.
Neither the hernia or stricture (arrow) due to reflux esophagitis
were visible early in the examination.
Paraesophageal hernia
Large hernias can cause symptoms, and with progressive hiatal
widening, increasing protrusion and rotation of the stomach
can lead to gastric volvulus that can be complicated by
hemorrhage, obstruction, strangulation, perforation.
Barrett's esophagus
Barrett's esophagus (columnar metaplasia) is
the result of long-standing reflux esophagitis.
Most patients have reflux and a hiatus hernia.
The diagnosis is strongly suggested by:
Mid or high esophageal ulcer
Mid or high esophageal web-like stricture
Reticular mucosal pattern
On the left a patient with a Barrett's
esophagus. The reticular mucosa is
characteristic of Barrett's columnar metaplasia,
especially with the associated web-like (arrow)
stricture.
Asymptomatic patient with a leiomyoma.
On the chest film an abnormal opacity is seen behind the heart
(arrow).
The barium study demonstrates a lobulated mass (arrow) that
does not obstruct despite its large size.
Pedunculated fibrovascular polyps are rare lesions, that are difficult to
diagnose on esophagrams.
Their movement during the examination producing an inconstant
position and shape may be suggestive as in this patient.
The stalk is often difficult to identify.
Patient with an early esophageal carcinoma.
Lesion is not visible on single contrast esophagram.
Air-contrast esophagram shows surface irregularity (arrows)
indicating a mucosal lesion.
This was both a small lesion and a pathologically early
squamous carcinoma.
Advanced carcinoma has many gross
appearances:
On the left two cases of polypoid
carcinoma.
On the left a patient with an infiltrative
ulcerated carcinoma.
This lesion has an abrupt transition forming
an acute angle and overhanging edge.
This indicates mural involvement and is
different than obtuse angles usually
produced by extrinsic lesions that are not
fixed to the esophagus
Barrett's esophagus and Adenocarcinoma
Barrett's esophagus is a proven risk factor for
the development of an adenocarcinoma.
The incidence of cancer in Barrett's however is
controversial.
Who, how, and when individuals should be
screened is unresolved.
Adenocarcinoma was 10% of esophageal
malignancies in 1960s.
Since 1960s, incidence increasing in USA
greater than any other carcinoma.
Incidence now approaching or exceeding
squamous carcinoma in Caucasian men in the
USA and Europe.
On the left a patient with an ulcerated (arrow)
plaque like adenocarcinoma in a Barrett's
esophagus.
