Caustic Esophagitis

Published on 05/08/2015 by admin

Filed under Radiology

Last modified 05/08/2015

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 Causes mild to severe injury to upper GI tract

– Esophagus > stomach > duodenum

IMAGING

• Imaging evaluation: CECT for acute injury; barium esophagram for chronic

image If esophagram done in acute phase, use nonionic, water-soluble agent (e.g., Omnipaque)
• Fluoroscopic: Esophagram

image Stage 1: Acute severe phase (1-4 days)

– Narrowed lumen with irregular contour/ulcerations
– May have signs of perforation (extraluminal gas and contrast medium)
image Stage 2: Ulcer granulation phase (5-28 days)

– More defined ulcers; spasm
image Stage 3: Cicatrization and scarring (3-4 weeks)

– Strictures, usually long and smooth, can be  irregular and eccentric
– Sacculations, pseudodiverticula
– Stomach is often pulled up into chest by esophageal shortening
• CT Findings

image Acute phase

– Target sign: Mucosal enhancement and hypodense submucosa
– Esophageal perforation: Pneumomediastinum, pleural effusion
image Chronic phase: Luminal irregularity and narrowing

– Similar findings in stomach ± duodenum

CLINICAL ISSUES

• Complications: Perforation, mediastinitis, peritonitis, fistulas, shock
image
(Left) Graphic shows a long stricture of the esophagus and ulceration of the mucosa. The stomach is pulled up into the chest due to foreshortening of the esophagus by fibrosis &/or spasm.

image
(Right) Spot film from a barium esophagram in a patient with chronic stricture image from caustic ingestion shows a shortened and strictured esophagus, with the proximal stomach image pulled into the chest. This stricture has been treated repeatedly by balloon dilation, and the patient has not required surgery.
image
(Left) Axial CECT of a patient 2 hours after caustic ingestion shows marked thickening of the esophageal wall image and bilateral aspiration pneumonitis.

image
(Right) Axial CECT in the same patient shows marked thickening of the gastric wall with submucosal edema image, indicating corrosive gastritis.

TERMINOLOGY

Synonyms

• Corrosive esophagitis

Definitions

• Esophageal injury due to ingestion of strong alkali or acid

IMAGING

General Features

• Best diagnostic clue

image Long stricture ± diffuse ulceration of esophagus
• Location

image 
• Morphology

image 

Radiographic Findings

• Chest PA and lateral views (acute)

image Dilated, gas-filled esophagus
image May show aspiration pneumonitis
image Esophageal perforation

– Pneumomediastinum, pleural effusion
• Fluoroscopic: Esophagram

image Stage 1: Acute severe phase (1-4 days)

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