Mayo clinic gastrointestinal imaging review free download

A wellcircumscribed, exophytic, enhancing tumor arrow is seen along the right side of the distal esophagus. Gastrointestinal stromal tumor 2. Fibroma, neuroma, neurofibroma, lipoma, hemangioma 3. Duplication cyst 4.

Lymphoma Diagnosis Gastrointestinal stromal tumor Discussion The location of the mass in relationship to the esophagus, its smooth surface, and the obtuse angle between the mass and the esophageal lumen suggest a submucosal mass. Gastrointestinal stromal tumors GISTs are the most frequently occurring submucosal neoplasm of the esophagus, accounting for more than half of all benign esophageal tumors.

They are more common in the mid esophagus and distal esophagus—segments where smooth muscle is most abundant. Most GISTs are found incidentally. Differential considerations include other types of intramural tumors such as fibromas, neuromas, neurofibromas, lipomas, and hemangiomas. Enteric duplication cysts or a lymphomatous mass could have a similar appearance. A focal and enhancing mass makes a neoplasm most likely at CT. Duplication cysts often show water attenuation and do not enhance with intravenous contrast material.

A lobulated filling defect is present in the distal esophagus. Adenoma 2. Papilloma 3. Inflammatory esophagogastric polyp Diagnosis Adenoma Discussion Adenomas of the esophagus are rare lesions arising from adenomatous tissue in the distal esophagus, usually within Barrett esophagus. Malignant degeneration has been reported in these lesions; therefore, endoscopic removal is recommended.

Large polyps are more likely to be malignant than small polyps. Esophageal papillomas fibrovascular excrescences that are covered with squamous epithelium can have a similar radiographic appearance and are probably more common than previously believed. These polyps are usually removed endoscopically, but no malignant transformation has been reported in humans.

Inflammatory esophagogastric polyps case 1. An enlarged polypoid fold extends from the stomach into the esophageal lumen. Inflammatory esophagogastric polyp 2. Adenoma 3. Papilloma Diagnosis Inflammatory esophagogastric polyp Discussion The inflammatory esophagogastric polyp is an enlarged gastric fold that projects into the lower esophagus. Inflammation is due to reflux esophagitis in affected patients.

These polyps have no malignant potential. Usual radiographic features are a clubbed, bulbous fold that arises from the fundus of the stomach and projects into the lower esophagus.

Occasionally, it may be difficult to differentiate an inflammatory esophagogastric polyp from a papilloma or an adenoma. In these cases, endoscopy is recommended to obtain a definitive diagnosis.

A and B. A large, smooth, intraluminal mass arising from a thin stalk is present in the cervical esophagus. The esophagus is dilated around the intraluminal mass. Fibrovascular polyp 2. Adenomatous polyp 3.

Spindle cell carcinoma carcinosarcoma 4. Intraluminal gastrointestinal stromal tumor Diagnosis Fibrovascular polyp Discussion Fibrovascular polyps are benign, pedunculated, intraluminal lesions composed of various mesenchymal elements. They are covered by normal squamous esophageal mucosa and usually occur in the cervical esophagus.

Fibrovascular polyp is the unifying term recommended for these lesions by the World Health Organization in In the past, they were named according to the predominant histologic component fibroepithelial polyps, pedunculated lipomas, fibrous lipomas, fibromyxomas, fibrolipomas. Fibrovascular polyps are typically longer than 7 cm and can exceed 20 cm in length. Occasionally, they present dramatically with regurgitation of the polyp into the pharynx.

This can result in respiratory compromise or even death. Fibrovascular polyps are not at risk for malignant transformation. Treatment of these lesions is surgical or endoscopic excision. Fibrovascular polyps often have a considerable lipomatous component and have fatty density on CT.

Adenomatous polyps case 1. Spindle cell carcinomas case 1. Gastrointestinal stromal tumor is also a diagnostic consideration, but it rarely has this large an endoluminal component and does not arise from a stalk. A large, centrally ulcerated mass with an irregular luminal contour and an abrupt inferior edge is present in the mid esophagus.

Primary esophageal carcinoma 2. Metastases 3. Lymphoma Diagnosis Ulcerative esophageal carcinoma squamous cell Discussion Features of a malignant mass include an irregular contour of the barium-filled lumen, abrupt shouldered edges, and an ulcer that does not project beyond the expected location of the normal esophageal mucosa. This case illustrates these features of a malignancy. Esophageal carcinoma is a highly lethal disease that usually presents with chest pain or progressive dysphagia.

Symptomatic tumors are often large and of advanced stage. Small tumors are usually discovered incidentally. Important risk factors in the development of esophageal cancer include tobacco and alcohol consumption, sex 3- to 4-fold increase in males , race twice as common in nonwhites , lye ingestion, achalasia, prior head and neck cancer, nontropical sprue, tylosis, Plummer-Vinson syndrome, and exposure to tannins and nitrosamines.

Tobacco and alcohol consumption are the most important risk factors in the United States. Squamous cell carcinomas and adenocarcinomas are the most common histologic types of esophageal cancers. Squamous cell tumors do not usually cross the esophagogastric junction, whereas adenocarcinomas arising in Barrett esophagus frequently extend into the stomach.

Most adenocarcinomas arise in Barrett esophagus and, as expected, are usually located in the distal esophagus. A large polypoid filling defect with irregular borders and abruptly shouldering edges is present within the distal esophagus. Esophageal carcinoma 2. Spindle cell carcinoma carcinosarcoma 3. Lymphoma Discussion An esophageal adenocarcinoma, spindle cell carcinoma carcinosarcoma case 1.

Squamous cell carcinomas rarely have this morphologic configuration. Adenocarcinomas nearly always arise within Barrett esophagus and are therefore usually located in the distal esophagus. Esophageal adenocarcinomas are increasing in frequency because of an increase in the number of patients with Barrett esophagus.

A large mass is present in the distal esophagus with associated thickened and nodular folds. An abrupt edge forms the superior margin of the tumor. Varices Discussion Most esophageal tumors do not have a varicoid appearance.

This type of adenocarcinoma has a substantial proportion of tumor extending within the submucosa, causing the distorted fold appearance. Tumors are fixed and rigid, unchanging with swallowing. Usually a peristaltic wave will not pass through such a diseased esophageal segment. Varices change shape, especially with passage of a peristaltic stripping wave cases 1. Marked distal esophageal wall thickening and calcification are present.

A large, finely calcified hepatic mass is also visible. Lymphoma 3. Peptic esophagitis 4. Infectious esophagitis Diagnosis Esophageal carcinoma with hepatic metastases Discussion The normal esophageal wall is less than 3 mm thick. Wall thickening by itself is a nonspecific finding; both benign and malignant processes can have this appearance. Often, endoscopy is necessary to determine the cause of the wall thickening.

Detection of paraesophageal invasion can be difficult, especially if the patient has a paucity of mediastinal fat or the fat planes are obliterated by operative or radiation therapy. Intravenously administered contrast material may help display tissue boundaries better in some patients with questionable findings. The presence of enlarged nodes 1. Metastases to normal-sized lymph nodes often undetectable at CT often occur in microscopic quantities.

In addition, even enlarged nodes can be due to benign inflammatory disease. Acute inflammatory changes can sometimes be distinguished from tumor infiltration by visualization of water attenuation within the thickened wall. Double-contrast barium esophagram. Distal esophagus has irregular luminal narrowing and nodularity. Discussion Esophageal adenocarcinomas nearly all arise from Barrett esophagus or from a fundal carcinoma extending into the esophagus.

The spread of adenocarcinoma resembles that of squamous cell carcinoma, except there is a higher likelihood of involvement of the gastric cardia or fundus. Radiographic features that suggest an adenocarcinoma rather than a squamous carcinoma include distal location, gastric invasion, and evidence for chronic reflux esophagitis.

CT can be used to identify mediastinal invasion and subdiaphragmatic extent of tumor. If extensive metastases are identified, the patient often receives radiation therapy rather than surgery. CT often understages tumors at the gastroesophageal junction. A circumferential soft tissue mass encases the esophagogastric junction. There is a polypoid, lobulated filling defect in the distal esophagus, and an associated extrinsic mass displaces the esophagus posteriorly.

Metastases Diagnosis Lung cancer with metastatic invasion into the esophagus Discussion CT not shown showed extensive mediastinal lymphadenopathy causing the changes on the esophagram.

Metastases to the esophagus usually arise from cancers of the stomach, lung, or breast. Most of these tumors metastasize to mediastinal lymph nodes, and with growth they can displace or directly invade the esophagus.

In some patients, the abnormality may resemble a primary esophageal cancer or present as a long, narrow stricture. Displacement of the lumen by a nodal mass is common.

The mid esophagus is most commonly affected because mediastinal lymph nodes are most often affected. Hematogenous metastases to the esophagus are unusual. A large lobulated and ulcerated mass constricts the distal esophagus. Varices Diagnosis Esophageal lymphoma Discussion The appearance of lymphoma can closely resemble that of primary carcinoma.

The most common intrinsic manifestation of lymphoma is a polypoid, ulcerative, or infiltrative mass—usually indistinguishable from primary esophageal cancer. Less frequently, submucosal infiltration of lymphoma results in varicoid folds, discrete small submucosal masses, or diffuse nodular changes.

Varices are usually more serpentine, and they change shape during fluoroscopic observation especially from a peristaltic stripping wave. A large, bulky filling defect is seen within the distal esophagus.

A pedicle arrow is seen attaching the tumor to the left side of the esophagus. Pedunculated gastrointestinal stromal tumor 2. Fibrovascular polyp 3. Spindle cell carcinoma 4. Adenocarcinoma Discussion Spindle cell carcinomas are rare malignancies that contain histologic elements of both carcinoma and sarcoma. In the past, these tumors have been called carcinosarcomas. These tumors usually appear as bulky, polypoid, intraluminal tumors in the mid or distal esophagus. The mass may expand the esophageal lumen, but obstruction is rare.

Multiple serpentine filling defects are seen in the distal esophagus. These defects changed in size and shape. Several esophageal varices are present within the distal periesophageal tissues. Esophageal varices 2. Hepatic cirrhosis is the most frequent cause of portal venous hypertension. Varices almost never cause dysphagia, but they can bleed and cause life-threatening hemorrhage.

The radiographic diagnosis of esophageal varices is most sensitive when the partially collapsed esophagus is examined. Varices can be obliterated by the filled, distended esophagus as well as the collapsed esophagus immediately after a stripping peristaltic wave. Varices appear as linear, often serpentine, filling defects with a scalloped esophageal contour.

Uphill varices are more prominent in the distal esophagus. The changing nature of varices with esophageal distention, peristalsis, and respiratory effort is helpful in differentiating varices from varicoid carcinoma case 1.

Tubular thickened folds arrows are present in the upper thoracic esophagus. Collaterals of the supreme intercostal vein, bronchial veins, and inferior thyroidal veins and other periesophageal collaterals enlarge and may be visible on an esophagram in the upper one-third of the esophagus.

Unlike uphill varices, which often cause gastrointestinal bleeding, downhill varices usually are asymptomatic. In fact, in clinical practice, these varices are rare. In the absence of the superior vena cava syndrome, other diagnostic considerations should be entertained, such as varicoid carcinoma case 1. Rarely, a varix is identified in patients without portal venous hypertension or superior vena cava obstruction.

Varices in these patients are considered idiopathic. These varices change size and shape as do varices of any cause with esophageal distention and after a peristaltic stripping wave. If the varix is thrombosed, it may be indistinguishable from a submucosal tumor.

Chest radiograph. There is a wellcircumscribed mass behind the heart. A paraesophageal mass with the attenuation of water is present in the lower mediastinum.

Differential Diagnosis Bronchopulmonary foregut malformation Diagnosis Esophageal enteric duplication cyst Discussion Esophageal duplication cysts are a type of foregut cyst, as are bronchogenic cysts and neurenteric cysts. Pathologically, esophageal duplication cysts are lined with squamous epithelium and have a smooth muscle wall.

Bronchogenic cysts have respiratory epithelium, and neurenteric cysts have associated vertebral body anomalies. Symptoms from these cysts can be caused by compression on the adjacent esophagus or tracheobronchial tree or by infection of the cyst.

If acid is secreted by the lining mucosa, peptic ulceration, perforation, and bleeding occur rarely. Esophageal duplication cysts can be located anywhere in the posterior mediastinum. Contrast esophagraphy usually shows an extramucosal smooth, well-demarcated mass, which is often impossible to differentiate from a gastrointestinal stromal tumor GIST case 1. A pair of shallow indentations approximately 2 cm apart are seen along the lateral wall of the cervical esophagus.

Ectopic gastric mucosa 2. Blistering skin disorder Diagnosis Ectopic gastric mucosa Discussion Ectopic gastric mucosa is thought to be a congenital abnormality, resulting from residue of columnar epithelium not replaced by stratified squamous epithelium during normal embryogenesis.

Ectopic gastric mucosa usually is located in the cervical esophagus, which is the last place in the esophagus to undergo replacement with stratified squamous epithelium.

The patches of ectopic gastric mucosa are usually less than 2 cm in diameter. Recognition of the characteristic radiographic features of this abnormality makes endoscopy and follow-up unnecessary. However, ectopic gastric mucosa occasionally results in dysphagia and appears polypoid or irregular in shape. An atypical appearance should be evaluated endoscopically. A blistering skin disorder could present with similar findings.

There is a bone fragment arrow in the region of the esophagus at the level of the C4 interspace. Differential Diagnosis Foreign body Diagnosis Esophageal foreign body Discussion This patient complained of food sticking and pain while eating chicken. A chicken bone was removed endoscopically.

Bony foreign bodies such as chicken or fish bones often lodge in the upper esophagus, whereas meat impactions case 1. Impacted bones often are best visualized on a lateral radiograph of the cervical region or at CT.

Contrast material may obscure a small fragment. An intraluminal filling defect is present in the distal esophagus just above the gastroesophageal junction. A was obtained, and the meat bolus passed into the stomach.

Impacted food typically lodges above the gastroesophageal junction. Several techniques can be used to remove the food.

Intravenously administered glucagon decreases pressure of the lower esophageal sphincter and may facilitate passage of the food bolus into the stomach.

Generally, if the bolus reaches the stomach, it will pass through the remainder of the alimentary tract without difficulty. Endoscopic retrieval is the traditional means of treatment.

Baskets and balloon catheters also have been used successfully to extract these foreign bodies. Effervescent granules and meat tenderizer have been used successfully by some, but they are not used in our practice because of the possible risk of perforation with these methods.

If an impaction has persisted for more than 24 hours, the risk of perforation increases because of possible transmural ischemia. Special care must be taken in these cases. It is important to examine the esophagus after the food bolus has passed or been removed in order to exclude an underlying lesion.

Subsequent esophagram shows that the filling defect is no longer present and also shows a lower esophageal ring. Foreign body 2. Esophageal carcinoma 3. Esophageal adenoma Diagnosis Esophageal foreign body Discussion This patient had a typical history of swallowing a large piece of meat and immediately experiencing odynophagia. Most common submucosal tumor 1.

Usually mm Hg contractions in conjunction with chest discomfort. Radiographically, peristalsis is normal. Some authorities believe that this disorder is a precursor to diffuse esophageal spasm. The principal differential consideration is vigorous achalasia case 1.

Achalasia can be excluded by a normal stripping wave in response to swallowing. Some patients are symptomatic, and others are not but have identical radiographic findings nonspecific motor incoordination. It is important to exclude other causes of chest pain, especially coronary artery disease, before attributing it to the esophageal abnormalities.

A ring circumferential impression is seen within the distal esophagus. At fluoroscopy, the ring was noted to be transient. Muscular ring A ring 2. Mucosal ring B ring Diagnosis Muscular ring A ring Discussion A muscular ring appears as a broad, smooth indentation in the lower esophagus, just superior to the esophageal vestibule. It is caused by a muscular thickening and can be observed to change shape and disappear at fluoroscopy.

A prominent muscular ring is encountered more often in patients with a hiatal hernia or gastroesophageal reflux and in some esophageal motor disorders. It is not known whether these associations are significant. The esophageal vestibule roughly corresponds in location to the manometrically defined lower esophageal sphincter and should not be confused with a hiatal hernia.

At fluoroscopy, a peristaltic wave can be seen to pass through this region. Often a mucosal ring B ring also is visible during the examination.

The B ring is a thin, fixed ring that does not change appearance and marks the location of the esophagogastric junction. There is a thin, smooth, circumferential filling defect at the gastroesophageal junction arrows with a small associated hiatal hernia. Schatzki ring 2. Chronic reflux stricture Diagnosis Schatzki ring Discussion A Schatzki ring is a symptomatic, thin constricting ring at the level of the gastroesophageal junction.

The pathogenesis of this condition is unknown. Most patients complain of dysphagia with solid foods. Large pieces of meat are often most troublesome. Treatment varies from instructions on chewing more carefully to endoscopic mechanical disruption of the ring with a bougie or pneumatic dilation. Radiographically, a thin, weblike constriction is present at the gastroesophageal junction.

A hiatal hernia is often present. Some patients experience dysphagia if the luminal diameter is between 10 and 15 mm at the level of the ring. Virtually all patients are symptomatic if the ring narrows to 10 mm or less. The term lower esophageal ring denotes a visible B ring that is asymptomatic. A Schatzki ring has a very characteristic appearance, and other conditions are rarely mistaken for it. It was originally defined as a B ring with luminal narrowing of 13 mm or less. A chronic reflux stricture should be longer and of different morphologic appearance.

A thin, smooth, shelflike filling defect is present along the anterior wall of the cervical esophagus. Esophageal web 2. Prominent anterior venous plexus Diagnosis Esophageal web Discussion Esophageal webs are thin folds composed of mucosa and submucosa which result in a 1- to 2-mm—wide shelflike filling defect along the anterior wall of the lower hypopharynx, pharyngoesophageal segment, or proximal cervical esophagus.

Occasionally, webs may be multiple and more masslike in configuration. Esophageal webs are usually asymptomatic. However, dysphagia can develop when the web results in marked luminal narrowing.

Clinically significant narrowing may present as a jet phenomenon, in which a thin column of barium jets through the center of a circumferential web. Many investigators have attempted to associate cervical esophageal webs with other conditions. The association between esophageal webs and iron deficiency anemia Plummer-Vinson syndrome remains controversial.

Reports also have suggested an association between webs and upper esophageal or pharyngeal carcinoma. The great majority of webs remain an isolated finding, often incidentally discovered without an associated disorder. Distinction of an esophageal web from the anteriorly located venous plexus may be difficult. Careful study of the venous plexus will show variability in its size, whereas a web remains fixed and unchanging from swallow to swallow. There is a prominent oblique, smooth-surfaced, tubular-shaped filling defect on the posterior aspect of the esophagus.

An aberrant right subclavian artery is present coursing posterior to the esophagus. Discussion An aberrant right subclavian artery is the most common aortic arch anomaly seen as an impression on the esophagus. The aberrant right subclavian artery arises just distal to the normal left subclavian artery and traverses obliquely to the right, posterior to the esophagus.

The impression is extramucosal and is so typical of the abnormality that no further studies are needed. The abnormality is rarely symptomatic and needs no treatment. There is dilatation of the esophagus with a small esophageal hiatal hernia. Real-time imaging showed absent peristalsis in the distal two-thirds of the esophagus and free gastroesophageal reflux of barium in the recumbent position. Slight irregularity is present at the gastroesophageal junction.

Pathologically, degeneration and atrophy of the smooth muscle and fibrosis are present within the distal two-thirds of the esophagus. Radiographic changes relate to decreased peristalsis in the distal two-thirds of the esophagus, with an incompetent lower esophageal sphincter. Gastroesophageal reflux and changes of peptic esophagitis often are observed.

Chronically, a lower esophageal stricture is often present. Diminished esophageal clearance results in stasis and the possibility of secondary esophageal candidiasis and aspiration pneumonitis.

Chronic reflux esophagitis can be complicated by Barrett esophagus. The appearance is indistinguishable from other causes of interstitial pulmonary fibrosis. Findings of scleroderma in the small bowel include diminished peristalsis, dilatation, sacculations, and closely spaced valvulae conniventes. Unenhanced high-resolution CT. Peripheral interstitial fibrotic changes are present in the lung bases with associated ground-glass infiltrates and traction bronchiectasis.

Pulmonary findings are consistent with nonspecific interstitial pneumonitis. Dilatation of the distal esophagus also can be seen with an air-fluid level. Scleroderma 2. A brief discussion of the disease is included.

Emphasis is placed on brevity of the text and a single-page layout for all but a few cases. Study guides at the end of each section are in the form of tables summarizing major radiographic findings into differential considerations with brief imaging clues to a specific diagnosis and case references within the book.

Toggle navigation. Main Mayo Clinic gastrointestinal imaging review. This is a comprehensive GI radiology review atlas and textbook with helpful study guides, high-quality images, and cases. The cases are presented so they can be viewed as unknowns, for aid with studying. The brief text is filled with essential facts that improve understanding of the field, as well as several findings, differential diagnoses, and pertinent information about the disease.

Study tables, differential lists, and references to those images are included in each chapter. Read more ISBN Hauser Stephen , Darrell S. Pardi , John J. Since Free ebooks since ZLibrary app. Please read our short guide how to send a book to Kindle The file will be sent to your email address. You may be interested in Powered by Rec2Me Most frequently terms diagnosis bowel findings contrast disease discussion differential diagnosis mass patients small bowel colon masses liver filling gastric tumor tumors chapter wall carcinoma multiple pancreatic gallbladder common metastases inflammatory enhanced ct lymphoma filling defects hepatic esophagus diseases obstruction esophageal syndrome pancreas duct duodenal folds bile pancreatitis benign mesenteric colitis ulcer adenocarcinoma abdominal diffuse ulcerative cystic focal thickening polyps abscess duodenum malignant masses and filling ducts spleen barium Related Booklists 0 comments Post a Review To post a review, please sign in or sign up You can write a book review and share your experiences.