Congenital tracheoesophageal fistula successfully diagnosed by CT esophagography

Tracheoesophageal fistula （TEF） or bronchoesophageal fistula may be congenital, inflammatory, neoplastic, or secondary to trauma. Congenital TEF or bronchoesophageal fistula is usually associated with esophageal atresia and is readily diagnosed in infancy. But if it is not associated with esophageal atresia, it may persist until adulthood. Some theories have been proposed to explain this delay in diagnosis. We present a case of a 70-year-old man with congenital TEF. The TEF was successfully diagnosed by multidetector-row CT esophagography.

Clinical Applications of Successive Spot Radiographs in Esophagography for Diagnosing the Early Esophageal Cancer

Objective:To introduce primary experience of clinical applications of successive spot radiographs in esophagography for the diagnosis of early esophageal cancer(EEC). Methods: Six patients with EEC were examined and diagnosed by a digital X-ray machine.According to the routine double contrast study of esophagus,the patient gulped a barium suspension in the upright position when the successive films were taken by 2 frames per second lasting for about 10 seconds.Various phases were obtained including barium-filled views,mucosal relief views and double contrast views. Results: Functional changes and abnormal mucosal folds of esophagus were present on successive spot radiographs of esophagography in patients with EEC and those patients with EEC were confirmed by endoscopic and pathologic findings.Four patients had mild loss of distensibility,2 patients had spasmodic contraction and 1 patient had barium retention.Thickened or interrupted folds were found in all cases.Little niches were detected in 5 of 6 patients. Conclusion: Evidence presented in barium studies of esophagus is more comprehensive and intact for the diagnosis of EEC when successive spot radiographs are employed.Functional changes of esophagus are more evident with this approach.

Esophageal intramural pseudodiverticulosis

Esophageal intramural pseudodiverticulosis(EIPD)is a disease of unknown pathogenesis characterized by usually systemic,cystic dilatation of the excretory ducts of esophageal submucosal glands.In this article,I review the epidemiology,clinical manifestations,endoscopic findings,esophagographic findings,and histopathology of EIPD.I also discuss the etiology and possible pathogenesis of EIPD based on my experiences with this disease and a review of the literature.EIPD usually presents with dysphagia in middle-aged individuals.It is often complicated with secondary infections,most commonly candidiasis.On esophagography,EIPD is delineated as small,multiple,flask-shaped outward projections within the esophageal wall.In recent years,EIPD has been mainly diagnosed by endoscopic findings of multiple,localized,small mucosal depressions.The orifices of the“pseudodiverticula”periodically open and close,and excrete mucus onto the mucosal surface.On histopathological examination,the luminal surface of dilated ducts in EIPD is covered by multilayered,hyperplastic epithelial cells,but myoepithelial cells in the glandular acini are well preserved.Treatment of EIPD is usually symptomatic therapy,and prevention of the infectious complications is important.The etiology and pathogenesis of EIPD are largely unknown,but functional abnormalities of autonomic nerve fibers innervating the esophageal glands likely play an important role,since the structures of the glands are basically preserved in this disease.

Primary esophageal lymphoma in immunocompetent patients:Two case reports and literature review

Primary lymphoma that involves the esophagus is very rare,with fewer than 30 cases reported in the Englishlanguage literature.Non-Hodgkin lymphoma accounts for most of the cases.Esophageal lymphomas have varied radiological appearances,which poses diagnostic difficulty.We report two cases of histopathologically confirmed primary diffuse large B-cell esophageal lymphoma and describe their radiological features,and briefly review the literature.

Congenital bronchoesophageal fistula in adults

AIM: To study the clinical characteristics, diagnosis and surgical treatment of congenital bronchoesophageal fi stulae in adults. METHODS: Eleven adult cases of congenital bronchoesophageal fistula diagnosed and treated in our hospital between May 1990 and August 2010 were reviewed. Its clinical presentations, diagnostic methods, anatomic type, treatment, and follow-up were recorded. RESULTS: Of the chief clinical presentations, nonspecific cough and sputum were found in 10 (90.9%), recurrent bouts of cough after drinking liquid food in 6 (54.6%), hemoptysis in 6 (54.6%), low fever in 4 (36.4%), and chest pain in 3 (27.3%) of the 11 cases, respectively. The duration of symptoms before diagnosis ranged 5-36.5 years. The diagnosis of congenital bronchoesophageal fistulae was established in 9 patients by barium esophagography, in 1 patient by esophagoscopy and in 1 patient by bronchoscopy, respectively. The congenital bronchoesophageal fistulae communicated with a segmental bronchus, a main bronchus, and an intermediate bronchus in 8, 2 and 1 patients, respectively.The treatment of congenital bronchoesophageal fistulae involved excision of the fistula in 10 patients or division and suturing in 1 patient. The associated lung lesion was removed in all patients. No long-term sequelae were found during the postoperative follow-up except in 1 patient with bronchial fistula who accepted reoperation before recovery. CONCLUSION: Congenital bronchoesophageal fistula is rare in adults. Its most useful diagnostic method is esophagography. It must be treated surgically as soon as the diagnosis is established.

CT Findings in Patients with Esophageal Carcinoma and Its Correlation with Esophagographic Findings

Aim of the Study: Aim of this study is to evaluate the patients of biopsy proven esophageal carcinoma with Contrast CT studies (CECT thorax, abdomen or neck), correlate and compare the CT findings with esophagographic findings in each case and with biopsy findings wherever possible. Materials and Methods: Fifty (50) biopsy proven cases of esophageal carcinoma were taken into study in Radiology Department of Govt. Medical College, Patiala, Punjab after informed consents. All the patients underwent esophagography with barium sulphate as the contrast material and contrast enhanced CT scan of neck and/or thorax and/or abdomen. In all cases, esophagographic study preceded the CT scan. The time gap between the two studies was kept to the minimum to make the studies comparable. Results: The CT findings were found to have significant correlation with the esophagographic findings (p value > 0.05 in each finding) in regard to luminal narrowing, proximal dilatation and hold up of contrast, eccentricity of growth, site involved, length of growth, involvement of pyriform sinuses/valeculla and involvement of GE junction. Conclusions: CT study primarily helps to rule out unresectable or distant metastatic disease. Barium studies cannot provide any information regarding local invasion into mediastinal structures, regional or non-regional lymphadenopathy or metastases to distant organs which are significant for determining the treatment modality. CT has an advantage over esophagography for these information.