Imaging Pearls ❯ Esophagus ❯ Tumors
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- “Water is often administered orally as a neutral contrast to ensure proper distension of the esophagus, although a CT esophagogram may also be performed by administering a single bolus of iodinated oral contrast that is swallowed at the start of the acquisition for adequately visualizing the esophagus.”
CT of the esophagus in the ER: what you need to know and what you need to remember.
Yasrab M, Crawford CK, Chu LC, Kawamoto S, Fishman EK.
Emerg Radiol. 2025 Apr 16.Epub ahead of print. PMID: 40238070. - Among the most severe esophageal emergencies is that of esophageal rupture or perforation. Spontaneous perforation can be caused by severe vomiting, retching, or even straining, owing to an acute increase in intraesophageal pressure contrasted with the negative intrathoracic pressure, in which case it is recognized as Boerhaave syndrome. On the other hand, mechanical injury to the esophageal wall caused by iatrogenic trauma, impacted food or true foreign body ingestion can also pose a high risk for subsequent perforation. Impaction is typically at the level of the cricopharyngeus muscle or the gastroesophageal (GE) junction due to increased external compression and anatomical narrowing.
CT of the esophagus in the ER: what you need to know and what you need to remember.
Yasrab M, Crawford CK, Chu LC, Kawamoto S, Fishman EK.
Emerg Radiol. 2025 Apr 16.Epub ahead of print. PMID: 40238070.
- “Gastrointestinal (GI) lymphoma accounts for 5–20% of extranodal lymphomas: the stomach is the most common site, followed by small intestine (ileum (60–65%), jejunum (20%−25%), and duodenum (6%–8%) and then colorectal lymphomas (6–12%)). GI lymphomas most commonly occur around the sixth decade of life and, although rare in childhood, they are the most common GI tumours in this age.”
Radiological Features of Gastrointestinal Lymphoma
Giuseppe Lo Re et al.
Gastroenterology Research and Practice Volume 2016, Article ID 2498143 - “Primary esophageal lymphomas account for less than 1% in all primary GI lymphomas, while usually result from lymph node metastasis of the lymphomas from the cervical or mediastinal region. Both findings on barium studies, as irregular filling defects, and on CT, as thickened esophageal wall with narrowed lumen, are nonspecific and mimic esophageal adenocarcinoma. However, CT may be useful to differentiate primary esophageal lymphoma from lymph node involvements in the cervical or mediastinal regions, in staging of the disease and in evaluating response to therapy.”
Radiological Features of Gastrointestinal Lymphoma
Giuseppe Lo Re et al.
Gastroenterology Research and Practice Volume 2016, Article ID 2498143
- Esophageal Obstruction
• Tumor
• adenocarcinoma of the gastroesophageal junction
• gastric cancer involving distal esophagus
• Stricture
• Sequela of severe or recalcitrant esophagitis
• Complication of lye ingestion
• Gastric volvulus
• Rare cause for esophageal obstruction
• Patients can have chronic asymptomatic gastric volvulus, but presence of acute pain, wall thickening and esophageal obstruction indicate surgical emergency
- “Despite its increasing incidence and high mortality, esophageal adenocarcinoma is predicted to account for only 1.1% of new cancer cases in the United States in 2014. An important reason that endoscopic screening and surveillance for Barrett esophagus has become widespread is physicians' concerns about medical professional liability claims. A recent analysis of data from a professional liability claims database suggests that such fears may be unfounded.The number of claims for either “failure to screen for esophageal cancer in patients without alarm features” or “complications from esophagogastroduodenoscopies with questionable indications” were similarly low.”
Screening and Surveillance for Barrett Esophagus Paul Lochhead, Andrew T. Chan JAMA Intern Med. 2015 Feb 1; 175(2): 159–160. - “Over the past 40 years, the incidence of esophageal adenocarcinoma has risen markedly in the United States, from 0.4 cases per 100 000 in 1975 to 2.6 cases per 100 000 in 2009. Barrett esophagus and esophageal adenocarcinoma share similar epidemiologic risk factors, including gastroesophageal reflux disease (GERD), white race, male sex, increasing age, tobacco use, and central adiposity.”
Screening and Surveillance for Barrett Esophagus Paul Lochhead, Andrew T. Chan JAMA Intern Med. 2015 Feb 1; 175(2): 159–160.
- “Leiomyoma accounts for 60%–70% of all benign esophageal neoplasms and is the most common benign tumor of the esophagus, while rare in the remaining gastrointestinal tract . The tumor is present more often in male patients (2:1) at a median age of 30–35 years. Usually, leiomyomas are between 2 and 8 cm in diameter. They are multiple in less than 3% of cases. Over half of the patients with esophageal leiomyoma are asymptomatic. Typical complaints are either dysphagia or substernal chest pain due to obstruction of esophageal bolus transit..”
Dedicated multi-detector CT of the esophagus: spectrum of diseases Ahmed Ba-Ssalamah et al. Abdominal Imaging Jan 2009, Volume 34, Issue 1, pp 3–18
- “Esophageal cancer is one of deadliest cancers worldwide and is the sixth leading cause of death from malignancies. Recent advances in the diagnosis, staging, and treatment of this neoplastic condition have led to small but significant improvements in survival. The lifetime risk of this cancer is 0.8% for men and 0.3% for women. The risk increases with age, the mean age at diagnosis is of 67 years. More than 90% of esophageal cancers are either squamous-cell carcinomas or adenocarcinomas.”
Dedicated multi-detector CT of the esophagus: spectrum of diseases Ahmed Ba-Ssalamah et al. Abdominal Imaging Jan 2009, Volume 34, Issue 1, pp 3–18 - “Tumor recurrence of esophageal cancer can be divided into locoregional recurrence and distant metastatic disease. The rate of recurrence of esophageal cancer even after curative surgery was found to be high in most reports. In the detection of tumor recurrence, the selected imaging modalities are important in many regards. First of all, the imaging modality must be suitable and cost-effective, and able to detect the pathology in the early stages. After esophagectomy and gastric excision, the anatomy of the posterior mediastinum is markedly changed. This makes the assessment of possible local tumor recurrence difficult. Wall thickening or adjacent mass and suspicious lymph nodes are highly predictive for recurrent disease .”
Dedicated multi-detector CT of the esophagus: spectrum of diseases Ahmed Ba-Ssalamah et al. Abdominal Imaging Jan 2009, Volume 34, Issue 1, pp 3–18
- “Multi-detector computed tomography (CT) offers new opportunities in the imaging of the gastrointestinal tract. Its ability to cover a large volume in a very short scan time, and in a single breath hold with thin collimation and isotropic voxels, allows the imaging of the entire esophagus with high-quality multiplanar reformation and 3D reconstruction. Proper distention of the esophagus and stomach (by oral administration of effervescent granules and water) and optimally timed administration of intravenous contrast material are required to detect and characterize disease. In contrast to endoscopy and double-contrast studies of the upper GI tract, CT provides information about both the esophageal wall and the extramural extent.”
Dedicated multi-detector CT of the esophagus: spectrum of diseases. Ba-Ssalamah A et al Abdom Imaging. 2009 Jan-Feb;34(1):3-18. - “Preoperative staging of esophageal carcinoma appears to be the main indication for MDCT. In addition, MDCT allows detection of other esophageal malignancies, such as lymphoma and benign esophageal tumors, such as leiomyma. A diagnosis of rupture or fistula of the esophagus can be firmly established using MDCT. Furthermore, miscellaneous esophageal conditions, such as achalasia, esophagitis, diverticula, and varices, are incidental findings and can also be visualized with hydro-multi-detector CT. Multi-detector CT is a valuable tool for the evaluation of esophageal wall disease and serves as an adjunct to endoscopy.”
Dedicated multi-detector CT of the esophagus: spectrum of diseases. Ba-Ssalamah A et al Abdom Imaging. 2009 Jan-Feb;34(1):3-18. - “Preoperative staging of esophageal carcinoma appears to be the main indication for MDCT. In addition, MDCT allows detection of other esophageal malignancies, such as lymphoma and benign esophageal tumors, such as leiomyma. A diagnosis of rupture or fistula of the esophagus can be firmly established using MDCT. Furthermore, miscellaneous esophageal conditions, such as achalasia, esophagitis, diverticula, and varices, are incidental findings and can also be visualized with hydro-multi-detector CT. Multi-detector CT is a valuable tool for the evaluation of esophageal wall disease and serves as an adjunct to endoscopy.”
Dedicated multi-detector CT of the esophagus: spectrum of diseases. Ba-Ssalamah A et al Abdom Imaging. 2009 Jan-Feb;34(1):3-18.