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Gastrointestinal Imaging

E2666. The Esophagus: What the Radiologist Needs to Know About Pathology and Postsurgical Evaluation

Mohandas A,  Daruwala V,  Abdelhadi S,  Gunduru M,  Grigorian C. Detroit Medical Center, Wayne State University, Detroit, MI

Address correspondence to A. Mohandas (

Background Information: A variety of congenital, infectious, inflammatory, and neoplastic esophageal abnormalities may be encountered while interpreting CT and fluoroscopy. Although esophageal cancer has an incidence of about 4 in 100,000 people, it has high morbidity and mortality. Moreover, evaluation of the esophagus after surgery is challenging due to extreme distortion of normal anatomy. The purpose of this exhibit is to review frequently encountered pathologic entities of the esophagus. Special attention will be given to interpreting findings in the esophagus after surgery.

Educational Goals/Teaching Points: Normal anatomy of the esophagus will be reviewed. Imaging characteristics of congenital, inflammatory, infectious, and neoplastic pathologic entities of the esophagus will be elucidated using radiographs, fluoroscopy, and CT. Points to keep in mind while evaluating the esophagus in the emergency room (ER) setting will be discussed. An overview of evaluating the esophagus after surgery and complications that may be encountered will be provided.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: We will review congenital esophageal abnormalities such as tracheoesophageal fistulas and atresia that cause significant symptoms and others such as webs and diverticula that may be asymptomatic. Esophageal ulceration, stricture, and stenosis are common presentations of esophageal abnormalities and may have infectious (viral or fungal), inflammatory (gastroesophageal reflux pathology), or neoplastic etiologic causes. We will review key imaging findings that will help differentiate between these entities in conjunction with the clinical information provided. In the ER setting, pneumomediastinum may be a result of esophageal rupture, which is associated with extremely high mortality and requires prompt diagnosis and repair. Esophagectomy may be performed via trans thoracic or trans-hiatal approach and will result in significant distortion of normal imaging findings. We will review key imaging points to be considered during postoperative follow-up and provide examples of different complications such as infection, anastomotic leak, and fistulas.

Conclusion: Abnormalities of the esophagus are encountered in everyday practice, and familiarity with the different pathologic entities and key imaging characteristics will aid in its interpretation. Evaluation of the esophagus after surgery provides a challenge, and knowledge of the appearance of different esophagus surgery complications will enable accurate diagnoses.