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DOI: 10.1148/rg.234025717
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(Radiographics. 2003;23:897-909.)
© RSNA, 2003

EDUCATION EXHIBIT

Radiologic Diagnosis of Benign Esophageal Strictures: A Pattern Approach1

Pia Luedtke, BA, Marc S. Levine, MD, Stephen E. Rubesin, MD, Donald S. Weinstein, MD and Igor Laufer, MD

1 From the Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (P.L., M.S.L., S.E.R., I.L.), and the Department of Radiology, Pennsylvania Hospital, Philadelphia, Pa (D.S.W.). Received October 14, 2002; revision requested November 22 and received December 9; accepted December 12. M.S.L. and S.E.R. are consultants with E-Z-Em Co, Inc, Westbury, NY. Address correspondence to M.S.L. (e-mail: levine@oasis.rad.upenn.edu).

Benign esophageal strictures are a leading cause of dysphagia. Therefore, radiologists have an important role in detecting esophageal strictures and determining their cause. The most common cause of strictures in the distal esophagus is gastroesophageal reflux disease. Reflux-induced ("peptic") strictures may be associated with sacculations, fixed transverse folds, or esophageal intramural pseudodiverticula. In addition, scleroderma, nasogastric intubation, Zollinger-Ellison syndrome, and alkaline reflux esophagitis may be associated with stricture formation in the distal esophagus. Upper and midesophageal strictures may be caused by Barrett esophagus, mediastinal irradiation, ingestion of drugs or caustic substances, congenital esophageal stenosis, skin diseases, or esophageal intramural pseudodiverticulosis. Other unusual causes of esophageal stricture formation include Crohn disease, Candida esophagitis, graft-versus-host disease, eosinophilic esophagitis, Behçet disease, endoscopic sclerotherapy for esophageal varices, and glutaraldehyde contamination at endoscopy. Esophageal strictures are best evaluated with biphasic esophagography that includes both single- and double-contrast spot images. When esophageal strictures are detected at barium examination, the underlying cause can often be determined with a pattern approach that takes into account the clinical history, the appearance and location of the strictures, and the presence of other associated radiographic findings.

© RSNA, 2003

Index Terms: Esophagus, 71.123, 71.744 • Esophagus, stenosis or obstruction, 71.744






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