Schatzki Ring

 Ring < 13 mm in diameter: Symptomatic


image Ring 13-20 mm: Occasionally symptomatic

image Ring > 20 mm in diameter: Asymptomatic


• Single-contrast barium esophagram
image Thin (2-4 mm in height), web-like constriction at gastroesophageal junction

image Margins: Smooth and symmetric

image Sliding hiatal hernia seen below ring

• Schatzki ring best visualized
image In prone right anterior oblique position

image During suspended deep inspiration and Valsalva

image With lumen distended with barium




TOP DIFFERENTIAL DIAGNOSES




• Reflux esophagitis

• Esophageal webs

• Esophageal carcinoma

• Muscular or contractile or A ring


CLINICAL ISSUES




• “Cheap steakhouse” syndrome: Due to inadequately chewed piece of meat impacted above ring

• Recurrent dysphagia; intermittent obstruction by food 
image Treatment: Mechanical disruption by bougienage or pneumatic dilation


DIAGNOSTIC CHECKLIST




• Need deep inspiration, Valsalva, distention to demonstrate Schatzki ring

• Give a 13 mm barium pill to judge diameter of ring

image
(Left) Graphic shows a small hiatal hernia image and an annular ring-like narrowing image at the gastroesophageal (GE) junction.


image
(Right) Film from a barium esophagram demonstrates a small hiatal hernia image and a Schatzki ring image with a luminal diameter of only 5-7 mm. Symptomatic narrowing of the B ring, which constitutes the Schatzki ring, probably results from reflux esophagitis.

image
(Left) In this young man with abrupt onset of chest pain after swallowing a piece of meat, a spot film from an esophagram shows a Schatzki ring image with the piece of meat image impacted above it.


image
(Right) Initial views of the esophagus (not shown) were normal. Repeat films, taken during deep inspiration and Valsalva maneuver, show the Schatzki ring image at the GE junction. This lesion can be missed if it is tilted relative to the plane of imaging or if the esophagus is not optimally distended.


TERMINOLOGY


Definitions




• Annular, inflammatory, symptomatic narrowing of normal lower esophageal mucosal or B ring


IMAGING


General Features




• Best diagnostic clue
image Thin, web-like, or annular constriction at gastroesophageal (GE) junction

• Size
image < 13 mm in diameter, up to 20 mm

• Other general features
Nov 16, 2016 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on Schatzki Ring
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