Thoracic Complications of Esophageal Disorders1
Ana Giménez, MD,
Tomás Franquet, MD,
Jeremy J. Erasmus, MD,
Santiago Martínez, MD and
Pilar Estrada, MD
1 From the Department of Radiology, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Avda Sant Antoni M. Claret 167, 08025 Barcelona, Spain (A.G., T.F., S.M., P.E.); and the Department of Radiology, M. D. Anderson Cancer Center, Houston, Tex (J.J.E.). Presented as an education exhibit at the 2001 RSNA scientific assembly. Received February 22, 2002; revision requested March 27 and received May 29; accepted June 14. Address correspondence to A.G. (e-mail: agimenez@hsp.santpau.es).
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Figure 1a. Multiple esophageal perforation due to chicken bone impaction in a 75-year-old woman with sensation of a foreign body, dysphagia, odynophagia, and drooling. (a) Barium esophagogram reveals a double esophageal tear. (b) Photograph of an autopsy specimen shows chicken bone impaction and perforation to the mediastinum. L = left perforation, R = right perforation.
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Figure 1b. Multiple esophageal perforation due to chicken bone impaction in a 75-year-old woman with sensation of a foreign body, dysphagia, odynophagia, and drooling. (a) Barium esophagogram reveals a double esophageal tear. (b) Photograph of an autopsy specimen shows chicken bone impaction and perforation to the mediastinum. L = left perforation, R = right perforation.
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Figure 2a. Spontaneous perforation of the esophagus (Boerhaave syndrome) with mediastinal abscess in a 58-year-old man with burning substernal pain. (a) Esophagogram shows a massive leak of barium to the mediastinum. (b) CT scan shows a periesophageal mediastinal abscess (arrow) with bilateral pleural effusion. A tube is present in the right side of the chest. A right paracardiac collection is also seen (*).
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Figure 2b. Spontaneous perforation of the esophagus (Boerhaave syndrome) with mediastinal abscess in a 58-year-old man with burning substernal pain. (a) Esophagogram shows a massive leak of barium to the mediastinum. (b) CT scan shows a periesophageal mediastinal abscess (arrow) with bilateral pleural effusion. A tube is present in the right side of the chest. A right paracardiac collection is also seen (*).
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Figure 3. Traumatic esophageal rupture with pneumomediastinum in a 53-year-old man. Contrast-enhanced esophagogram shows esophageal rupture with a right-sided paraesophageal collection of meglumine diatrizoate (arrows). Linear streaks of mediastinal air and extrapleural air that outline the diaphragm ("continuous diaphragm") are also shown (arrowheads).
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Figure 4. Classification scheme for esophageal atresia and tracheoesophageal fistula. Drawings show atresia with upper fistula (A), atresia with both lower and upper fistulas (B), atresia with lower fistula (C), and tracheoesophageal fistula with no atresia (D). (Modified, with permission, from reference 9.)
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Figure 5. Respiratory difficulty after feedings in a 3-day-old boy. Barium esophagogram clearly shows an H-shaped fistula between the trachea and the middle segment of the esophagus (arrowhead). Barium is filling the bronchi of the right lower lobe (arrows).
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Figure 6a. Advanced esophageal squamous carcinoma with tracheal invasion in a 68-year-old man. (a) Left lateral chest radiograph shows a large posterotracheal mass (*). (b) Contrast-enhanced CT scan shows an esophageal mass with tracheal invasion (arrowhead). (c) Virtual endoscopic image shows posterior invasion of the trachea (arrowheads). A = anterior, P = posterior.
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Figure 6b. Advanced esophageal squamous carcinoma with tracheal invasion in a 68-year-old man. (a) Left lateral chest radiograph shows a large posterotracheal mass (*). (b) Contrast-enhanced CT scan shows an esophageal mass with tracheal invasion (arrowhead). (c) Virtual endoscopic image shows posterior invasion of the trachea (arrowheads). A = anterior, P = posterior.
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Figure 6c. Advanced esophageal squamous carcinoma with tracheal invasion in a 68-year-old man. (a) Left lateral chest radiograph shows a large posterotracheal mass (*). (b) Contrast-enhanced CT scan shows an esophageal mass with tracheal invasion (arrowhead). (c) Virtual endoscopic image shows posterior invasion of the trachea (arrowheads). A = anterior, P = posterior.
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Figure 7a. Esophageal carcinoma with esophagopulmonary fistula secondary to radiation therapy in a 63-year-old man. (a) Barium esophagogram shows a large esophagopulmonary fistula. (b) CT scan also shows a large ulceration, with barium in the right upper lobe.
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Figure 7b. Esophageal carcinoma with esophagopulmonary fistula secondary to radiation therapy in a 63-year-old man. (a) Barium esophagogram shows a large esophagopulmonary fistula. (b) CT scan also shows a large ulceration, with barium in the right upper lobe.
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Figure 8a. Hodgkin disease (nodular sclerosis) in a 42-year-old man with esophagopulmonary and esophagomediastinal fistulas. (a) Contrast-enhanced CT scan shows a mediastinal lymphadenopathic mass with esophageal involvement and esophagomediastinal fistula. (b) Contrast-enhanced CT scan shows an esophagopulmonary fistula (arrowheads). Extensive vertebral body involvement is also shown.
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Figure 8b. Hodgkin disease (nodular sclerosis) in a 42-year-old man with esophagopulmonary and esophagomediastinal fistulas. (a) Contrast-enhanced CT scan shows a mediastinal lymphadenopathic mass with esophageal involvement and esophagomediastinal fistula. (b) Contrast-enhanced CT scan shows an esophagopulmonary fistula (arrowheads). Extensive vertebral body involvement is also shown.
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Figure 9. Esophagopleural fistula secondary to caustic esophagitis in a 13-year-old boy who ingested concentrated sodium hydroxide. Esophagogram shows a long fistula to the left pleural space. Meglumine diatrizoate swallow shows a diffusely stenotic esophagus.
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Figure 10a. Barium aspiration in the left lower lobe. (a) Gastroesophagogram shows nodular and linear branching opacities in a bronchiolar distribution due to barium aspiration (arrowheads). A hiatal hernia is also shown. (b) Photomicrograph of an autopsy specimen shows birefringent aspirated material that corresponds to barium (*).
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Figure 10b. Barium aspiration in the left lower lobe. (a) Gastroesophagogram shows nodular and linear branching opacities in a bronchiolar distribution due to barium aspiration (arrowheads). A hiatal hernia is also shown. (b) Photomicrograph of an autopsy specimen shows birefringent aspirated material that corresponds to barium (*).
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Figure 11. Achalasia and aspiration bronchiolitis in a 62-year-old woman. High-resolution CT scan shows a markedly dilated esophagus and multiple bilateral tubular or branched filled bronchioles.
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Figure 12a. Zenker diverticulum and aspiration bronchiolitis in a 68-year-old woman with cough and halitosis. (a) Posteroanterior chest radiograph shows an air-fluid level (arrowheads). (b) CT scan shows aspiration bronchiolitis in the left upper lobe with multiple filled bronchioles.
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Figure 12b. Zenker diverticulum and aspiration bronchiolitis in a 68-year-old woman with cough and halitosis. (a) Posteroanterior chest radiograph shows an air-fluid level (arrowheads). (b) CT scan shows aspiration bronchiolitis in the left upper lobe with multiple filled bronchioles.
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Figure 13a. Esophageal carcinoma with lung aspiration in a 58-year-old man. (a) CT scan shows polypoid carcinoma in the middle third of the esophagus (arrow). (b) CT scan (lung window) obtained at a higher level than in a shows aspiration bronchiolitis in the right upper lobe.
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Figure 13b. Esophageal carcinoma with lung aspiration in a 58-year-old man. (a) CT scan shows polypoid carcinoma in the middle third of the esophagus (arrow). (b) CT scan (lung window) obtained at a higher level than in a shows aspiration bronchiolitis in the right upper lobe.
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Figure 14a. Polymyositis and aspiration pneumonia in a 53-year-old woman. (a) Posteroanterior chest radiograph shows bilateral alveolar infiltrates. (b) High-resolution CT scan obtained at the level of the upper lobes shows an esophageal dilatation related to esophageal dysmotility. An air-fluid level in the esophagus is also shown (arrowhead). (c) CT scan obtained at a lower level than in b shows a left upper lobe infiltrate related to aspiration pneumonia.
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Figure 14b. Polymyositis and aspiration pneumonia in a 53-year-old woman. (a) Posteroanterior chest radiograph shows bilateral alveolar infiltrates. (b) High-resolution CT scan obtained at the level of the upper lobes shows an esophageal dilatation related to esophageal dysmotility. An air-fluid level in the esophagus is also shown (arrowhead). (c) CT scan obtained at a lower level than in b shows a left upper lobe infiltrate related to aspiration pneumonia.
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Figure 14c. Polymyositis and aspiration pneumonia in a 53-year-old woman. (a) Posteroanterior chest radiograph shows bilateral alveolar infiltrates. (b) High-resolution CT scan obtained at the level of the upper lobes shows an esophageal dilatation related to esophageal dysmotility. An air-fluid level in the esophagus is also shown (arrowhead). (c) CT scan obtained at a lower level than in b shows a left upper lobe infiltrate related to aspiration pneumonia.
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Figure 15a. Gastric aspiration and obliterative bronchiolitis in a 68-year-old woman with achalasia. (a) Posteroanterior chest radiograph shows a hyperlucent zone in the right lower lobe with associated volume loss and a reduced number of lung vessels (arrows). (b) Prone expiratory CT scan shows decreased lung attenuation in the right lower lobe. The size and number of vessels are reduced. These findings are consistent with the presence of bronchiolar inflammatory disease with air trapping.
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Figure 15b. Gastric aspiration and obliterative bronchiolitis in a 68-year-old woman with achalasia. (a) Posteroanterior chest radiograph shows a hyperlucent zone in the right lower lobe with associated volume loss and a reduced number of lung vessels (arrows). (b) Prone expiratory CT scan shows decreased lung attenuation in the right lower lobe. The size and number of vessels are reduced. These findings are consistent with the presence of bronchiolar inflammatory disease with air trapping.
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Figure 16. Lung fibrosis related to a hiatal hernia with repetitive lung aspirations in a 63-year-old man. High-resolution CT scan shows a prominent reticular pattern with traction bronchiectasis and a hiatal hernia.
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Copyright © 2002 by the Radiological Society of North America.
