Candida Esophagitis

 Mucosal plaques in immunocompromised patients


image Predominantly mid or upper esophagus

image Plaques: Several mm in size, usually < 1 cm

image Longitudinally oriented plaques

image 90% sensitivity in detecting Candida esophagitis





PATHOLOGY




• Most common cause of infectious esophagitis
image Only 50% of patients with Candida esophagitis are found to have thrush


CLINICAL ISSUES




• Odynophagia (sharp pain on swallowing)

• Immunocompromised patients
image Occurs in patients with AIDS, hematologic malignancies

• Other patients with physiologic or mechanical obstruction of esophagus and local stasis (e.g., achalasia)

• Usually self-limited with rapid response to oral therapy


DIAGNOSTIC CHECKLIST




• Odynophagia with plaques in immunocompromised patient should suggest candidiasis

• Plaques are raised mucosal lesions; if central contrast collection is present then lesion is ulcer

• Oral thrush plus odynophagia is presumptive evidence of Candida esophagitis

image
(Left) Graphic shows longitudinally oriented mucosal plaques characteristic of Candida esophagitis.


image
(Right) Double-contrast barium esophagram shows longitudinally oriented filling defects representing Candida plaques image. This modality is quite accurate in depicting the characteristic mucosal plaques, ulcers, and less common manifestations of Candida esophagitis. However, in most patients, the combination of odynophagia and oral thrush is sufficient to make the diagnosis and begin treatment.

image
(Left) Esophagram shows a shaggy appearance of the esophagus due to ulcers and raised plaques. Note the innumerable pseudodiverticula image, which are narrow, flask-shaped dilations of excretory ducts. These nonspecific findings have also been observed in patients with chronic esophagitis or dysmotility syndromes.


image
(Right) Esophagram shows a severely irregular surface pattern, due to innumerable plaques and ulcers. A mild stricture was present in the upper esophagus (not shown).


TERMINOLOGY


Synonyms




• Esophageal candidiasis, moniliasis


Definitions




• Infectious esophagitis caused by fungi of Candida species, usually Candida albicans


IMAGING


General Features




• Best diagnostic clue
image Mucosal plaques in immunocompromised patient

• Location
image Any part or entire esophagus


Fluoroscopic Findings




• Double-contrast esophagram
image Discrete plaques with longitudinal orientation
– Plaques are raised mucosal lesions (filling defects in barium pool); if there is central collection of barium, then lesion is an ulcer

image “Cobblestone” or “snakeskin” appearance with confluent plaques

image Severe cases: Deep ulcers

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Nov 16, 2016 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on Candida Esophagitis
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