Esophagus: Differential Diagnosis







TABLE 28-1

Ulceration



























































































Cause Radiographic Findings Distribution Comments
COMMON
Reflux esophagitis Shallow, punctate, or linear ulcers; deep ulcers less common Distal Reflux symptoms, hiatal hernia, and/or gastroesophageal reflux
Candida esophagitis Ulcers associated with diffuse plaque formation (“shaggy” esophagus) Variable Odynophagia in immunocompromised
(usually AIDS) patients
Herpes esophagitis Discrete superficial ulcers Middle or distal Odynophagia in immunocompromised patients; occasionally in healthy patients
Drug-induced esophagitis Discrete superficial ulcers; occasionally giant, flat ulcers Midesophagus near aortic arch or left main bronchus Odynophagia in patients taking oral medications (e.g., doxycycline or tetracycline)
UNCOMMON
Radiation esophagitis Superficial or deep ulcers Conform to radiation portal History of radiation therapy
Caustic esophagitis Superficial or deep ulcers Variable History of caustic ingestion
Tuberculous esophagitis Superficial or deep ulcers Variable History of pulmonary tuberculosis or AIDS
Cytomegalovirus esophagitis One or more giant, flat ulcers Variable AIDS patients with odynophagia
HIV esophagitis One or more giant, flat ulcers Variable HIV-positive or AIDS patients with odynophagia
Crohn’s disease Aphthoid ulcers Variable Advanced Crohn’s disease in small bowel or colon
Nasogastric intubation Shallow ulcers or giant, flat ulcers Distal History of intubation
Alkaline reflux esophagitis Superficial or deep ulcers Distal Partial or total gastrectomy
Behçet’s disease Superficial ulcers Variable Oral and genital ulcers and ocular inflammation
Epidermolysis bullosa dystrophica Superficial ulcers or bullae Variable Skin disease
Benign mucous membrane pemphigoid Superficial ulcers or bullae Variable Skin disease


TABLE 28-2

Mucosal Nodularity































































Cause Radiographic Findings Distribution Comments
COMMON
Reflux esophagitis Nodular or granular mucosa (nodules poorly defined) Distal third or half of thoracic esophagus Reflux symptoms, hiatal hernia, and/or gastroesophageal reflux
Candida esophagitis Discrete plaques Localized or diffuse Odynophagia in immunocompromised patients
Glycogenic acanthosis Nodules or plaques Localized or diffuse Asymptomatic
UNCOMMON
Barrett’s esophagus Reticular pattern Localized Often adjacent to distal aspect of midesophageal stricture
Radiation esophagitis Granular mucosa and decreased distensibility Conforms to radiation portal Temporal relationship to radiation therapy
Superficial spreading carcinoma Poorly defined, coalescent nodules or plaques Localized or diffuse May be asymptomatic
Esophageal papillomatosis Multiple excrescences Diffuse Asymptomatic
Acanthosis nigricans Tiny nodules Diffuse Skin disease
Cowden’s disease Tiny nodules (hamartomatous polyps) Diffuse Hereditary disorder with associated malignant tumors of skin, gastrointestinal tract, and thyroid
Leukoplakia Tiny nodules Localized or diffuse Rare

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Jun 23, 2019 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on Esophagus: Differential Diagnosis

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