Caustic Esophagitis

Published on 05/08/2015 by admin

Filed under Radiology

Last modified 05/08/2015

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 0 (0 votes)

This article have been viewed 1243 times

 Causes mild to severe injury to upper GI tract

– Esophagus > stomach > duodenum


• 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


• Complications: Perforation, mediastinitis, peritonitis, fistulas, shock
(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.

(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.
(Left) Axial CECT of a patient 2 hours after caustic ingestion shows marked thickening of the esophageal wall image and bilateral aspiration pneumonitis.

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



• Corrosive esophagitis


• Esophageal injury due to ingestion of strong alkali or acid


General Features

• Best diagnostic clue

image Long stricture ± diffuse ulceration of esophagus
• Location

• Morphology


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)


Buy Membership for Radiology Category to continue reading. Learn more here