with permission.
Figure 6.63 Early esophageal carcinoma. Double‐contrast view shows a plaque‐like lesion (black arrows) in the mid esophagus with a flat central ulcer (white arrows).
Figure 6.64 Early adenocarcinoma in Barrett’s esophagus. Double‐contrast view shows a long peptic stricture in the distal esophagus above a hiatal hernia. Also note irregular flattening (arrows) of one wall of the stricture. Endoscopic and surgical biopsy specimens revealed an early adenocarcinoma arising in Barrett’s esophagus.
Source: Reproduced from Levine et al. [129], with permission.
Figure 6.65 Superficial spreading carcinoma. Double‐contrast view shows focal nodularity of the mucosa in the mid esophagus. Note how the nodules are poorly defined, producing a confluent area of disease. This appearance should be highly suspicious for a superficial spreading carcinoma.
Source: Reproduced from Levine MS. Radiology of the esophagus. Philadelphia: WB Saunders, 1989, with permission.
Figure 6.66 Infiltrating squamous cell carcinoma. Double‐contrast view shows an irregular area of narrowing in the mid esophagus with nodularity and ulceration of the narrowed segment. Also note the abrupt, shelf‐like margins of the lesion.
Figure 6.67 Polypoid squamous cell carcinoma. Double‐contrast view shows a polypoid mass (arrow) in the mid esophagus.
Figure 6.68 Primary ulcerative squamous cell carcinoma. Double‐contrast view shows a large meniscoid ulcer (arrows) surrounded by a thick rind of tumor in the distal esophagus.
Source: Reproduced from Levine MS. Radiology of the esophagus. Philadelphia: WB Saunders, 1989, with permission.
Figure 6.69 Infiltrating adenocarcinoma. Double‐contrast view shows an irregular area of narrowing in the distal esophagus. Note how the lesion extends into the proximal edge of a hiatal hernia. This patient had an adenocarcinoma arising in Barrett’s esophagus.
Source: Reproduced from Levine MS. Radiology of the esophagus. Philadelphia: WB Saunders, 1989, with permission.
Figure 6.70 Schatzki ring. (A) Double‐contrast view shows no evidence of a ring in the distal esophagus, but the region abutting the gastroesophageal junction is not optimally distended. (B) Prone single‐contrast view from the same examination shows a smooth, symmetric ring‐like constriction (arrow) at the gastroesophageal junction above a hiatal hernia. This Schatzki ring caused intermittent dysphagia for solids.
Pulsion diverticula
Pulsion diverticula tend to be located in the distal esophagus and are often associated with fluoroscopic or manometric evidence of esophageal dysmotility. The diverticula are usually detected as incidental findings in patients who have no esophageal symptoms. However, a large epiphrenic diverticulum adjacent to the GEJ may fill with debris, causing dysphagia, regurgitation, or aspiration (Figure 6.71). Pulsion diverticula appear on barium studies as rounded outpouchings from the esophageal lumen that have wide necks. They often do not empty completely when the esophagus collapses and may be associated with other radiologic findings of esophageal motor dysfunction.
Traction diverticula
Traction diverticula occur in the mid esophagus and are most commonly caused by scarring from tuberculosis or histoplasmosis involving perihilar or subcarinal lymph nodes. Traction diverticula are true diverticula containing all layers of the esophageal wall and therefore maintain their elastic recoil. As a result, they tend to empty their contents when the esophagus collapses at fluoroscopy. Traction diverticula often have a triangular or tented appearance resulting from traction on the diverticulum by the fibrotic process in the adjacent mediastinum (Figure 6.72). Thus, it is often possible to distinguish traction diverticula from pulsion diverticula on the basis of the radiographic findings.
Figure 6.71 Giant epiphrenic diverticulum. Single‐contrast view shows a large epiphrenic diverticulum (large arrow) arising from the right lateral wall of the distal esophagus. Note the wide neck (small arrows) of the diverticulum.
Esophageal intramural pseudodiverticula
Esophageal intramural pseudodiverticula consist pathologically of dilated excretory ducts of deep mucous glands in the esophagus. The pseudodiverticula typically appear on esophagography as flask‐shaped outpouchings in longitudinal rows parallel to the long axis of the esophagus [135] (Figure 6.73A). The pseudodiverticula classically have a diffuse distribution in the esophagus and are sometimes associated with strictures in the upper or mid esophagus [135]. However, it is more common to have an isolated cluster of pseudodiverticula