.•. gore IIL·I Normal esophagus.~.

: Atthethoraeie i A
[al"'rDW') •. B: In the midthoraK,

inlet, the esophag.s

li.es jast lelt elmidline
(arroW') .•. The '(':':

i.t closely a•• ts the lelt. mai.lIste.mhranehas
(arrow-) everlJl'ingthe

esephagus ah.tstheperieardi.am lelt ple.raJ. spaee'bythe

lelt atri.um (A)~, is preteeted It

Iram the

descendi.ng aorta (.DJ •.

Ji'ig!llre •• -2 Esephageal dellsi,tyeent:ellts.

dlllpli,eati,ell cyst (ar:ro·w:I",;~ad.s),., Netethi,n

smeoth 'W'all alld near-W"ater-

Fig\JI:re· .Jl-!i Esephageal the distal esephagas

,adeReearei,nema,., A: 'There is i,rreg.lar", ei,reumiereRti,althieke:ning lymph :II.de (a.l"'roW'),., Although

01
it

(arro'W') W'i,th e:l:i1:ensiollnto the gastrie i

eardia .. B,: Tamer e:!::teRdsalong the note is made elthe

lesser curve (,eurv:e,tI arrDW'),. There is a small gastrohepatie measures: less than I. em" i,t centai,Red. malignant Red.lar liver i,n this patiellt 'W'i,theirrhDsis.

!cel.lsat s.rgery,.,IReidental

.F.igur!e •• -4 Esepllageal ade.eearei.Doma. A: As iathe prior ease,there is irreg.lar, ei.re.mlerentialthi.ekelling 01 the distal e:50phag.s (.a,rrDIV] .• There is also a pulmonary
metastasi.s (arrow)~ B:I:magetllreugh .. the .pper a"b.omeR reveals enlarged. gastrehepati.e lymph Rodes I.asteris!ks) that W'ere positive lor metastases.

Figure •• -5 Metastatic

eelon cancer. A: C:'T threugh

the chest reveals tumor eneasi,llg the with ,an ,ai,r·lluid. level. The 'by metastatic [efl:rr:ed arrolV).., ,B:lmage at the level

mediasti,uu:m ,and lelt hemitltrOra.:., Tile esophagus aorta is narroW'ed'hytumor, Iymphad.enepatky 01 'the earina sheW's erOmplete rO.literatio. Irom eelon caReer"

(aI'''''"') ,is dilated

'Wltie. ee:n.tai,ns ealeilie,atioRs

rOltlte eSrOpkageallume.

Figure

•• -6' Es.phageal

perl.rati.n

.... The pati.eat i.s a. 6:1·year-.ld w.man

w.ith .ist.ry

.1 he:nign alter the

distal esophageal strict.re eating lish. End.seopy water .. oluhle swallow s

secoadary

te rell.lI ...·Pati.e.t preseftted ...vi.th severe chest pai.

revealed a I.:og segment stri.eture

that was aeti.v·ely hleedi.:ng.•. :ni.ti.al I gas,. presumablyintredaeed d.riftg i.ftthe layer (ellrv:etl

di.d.net reve,al a leak., and a ,CTwas perlermed.~ . .4.: :I:magethro.gh the esophageal wall •.This mural gas islyiftg (a.rl'"lolV) and the museular

chest usiRg IUHgwindew·s shows e:::lte:osi.ve ediastinal m eftdeSc0py .•. iri.s also .idelltilied within A
a;.rrDW"). :B: Ellteftsi.ve retroperitoReal.

submHcosa" ni.eely deli.Reati.Rgt:he i.BDermueosallayer i.ntram.ral gas (arrolV)th,at

gas i.s preseHt 011. this .pper .. hdomi.nal i.mage... ietethe a N T:he pati.ent was treated

lias dissected i.• the stemach. t.

eOHservatively ,aRdrecovered.".

Figu:trie •• -7 Esophageal i,lltr,am.r,al hematoma. (lI)tllat olloW'er esophagas aro.Hdtlte lor treatment .. hemat:ama,.,At: theti,me elthe

developed. d.ring

pRe.matie

dila.1:at:l,o. drapes

01 aehalasia,. The 111IIid·li,lled l.meD _I the esophagas el(,ami.atioH"the

hemat:ama W"as .:(,0 days 01d aMd. I. I

longer ol,ltigh at'tenaatioll

Figure .... S M.ltiple

large esophageal vari.ees {arrows] appear as eRhaR.eillgt.h.lar

st:raet.res

aJ.oRgsi.dethe esephaglls (1:) .•. otice t.ei.r density is eq.al t:o'the adjacent aorta. N

Figure! II .. Aehalasi.a ..Tile esophagas 9 nasogastri.et •• e (arrow) that e.ald

is dilated and eontai.lls lood and II.id and a eoiled esopha.geal sphiaetel"lI.

l1..t"be passed ae ... sst:he I.wer

Jlig,ureJlJl",JI. Di,ll.se esophageal en1:i,retll.raei,e

spasm ..There is: symme1:rie m.ral1:llieke:ning is smeoth,a.dthere is •• I.miRal

{arI"'DlVs} .1 the

es.p.agus.~. Yhethi.ekeni.ng

dila1:a:1:i .•R.

.Figure·.lI-ll•. F_.depliea'tieH".
t.he e•• rsesthro.gh .a.ovethe esophagealhiat.s

Y'he I_.d_s

(arrDW's) is 'Wrapped ar.uadthe

distal esophagus,,,. ·N!G 'Wrap lies

the esophagus,,,. Niote that there (,ellrv:ed arrDW's).

is

,3

slidiaghiatal

herRia., a.dthe

Fi:g.ure!3 O'-5, Leii:o,my,o'1i1Il3o,f Ih~e ,es!o'pba;gu~s:~CTs'C3.nsbo:ws ,a n.eicic,e!n,tri'c mass ,(arnJwhe:ad's) 'of th'eeso'p,hagus IIOliO ogien'eo(l,s .50ft ti~sSI(l'e,aHemu a,tJion~
I

,at II1I~el:eve,I,o'fthe! ,clari'na,~Th~el:esi'o,nshoiWs ,3S01'0o,lhmar'g'i'na,nd

Figllu,e 30·6 Ca.lic:ilfi:ed'11eiioliDy,(nna f' theesop'ha'gus,~ o nlulitiilo:c,a!11 ,c,a!licUiiic,a.ii:o,ns ,(aRlJW5)..

JCTsic~a.ndemonstrates

,cioucle'o.bi:c waUl th:i:cl!en:iin,g {arrowheads} of the! 'ga:stroesop,h,a.g'ea'il jiu ncti:on .. Thisl:e:s;iOln ,contaiins; ,

Fi:glllr,e ,3,0 '1' F~iib.r,ova,S'cQ,lar .. po:liyp, of thees,Otp,h.a'gu;s~ 'CT scan S,IiJ,OW5, ,aI1ar:D,eilnballumiin,al: polyp o:id D1,ass (a'TllJws}expandiing the ,llu Ole,n,,g,f tbe 'es:op,bag us, The ou,ters,u na,cie of the Dla,ss;iis w,elll d,efineda,ndclOntaiins ,centra,ll ,1!Orwa,Hen ua,tl:i:on,(asted:skJ r,esltdtiing from ;adiipose tiis:s,ue ,clOmponent~

F:i'gulI",e,30 ..8S,maUI,csUi Icall"'C;i~nolna IOf thle !esiOplha,gos,~ A, 'CT scaaat tbel!e¥eill IOf ;aodi:c ,ar,ch, d,eDlonstli"aies. ,ecic,entli":ic waUl th'i:c~eniing with ~soft tiis,su,e ,aUenua,tiio,niin, thle pill"oxiimall ,es:o'p,ha,gmls {aTrowheadst Th,e'es1o'p,hao,ea:11 ,1,o,lD,em ,farrow} iils:lilled \¥,iith, <co,ntra.st: m;ediiuin ~B"CT s!C:am 0" title up'p,er a,bd o,m,en de'liI1olnstll",a,tes iiI1ll.1lti!pl:eem~llar'g~e:dliYDlp,h n,odes {anowl1:ea'eJ:s}iinth'e pel:i:gla:sl:ri:c ;ar,ea.,

Fi:gllue ·30..101 ,6 a stro:iinites,tiim all :siro013.11tUOlor of tbe ,e.sop,li1'agu:s~'CTslcao.slllows: ;aliargie weill!.d·efiin,ed bias, ,c,enira'il ulic1er,ati:oln(U) tha,t ,co'Olnlun'ic:a,ie,s,wiith diis:p:l!a,cled ,es,o!pih,agea'~ 'Iiu en, (asterisk)., III

,exop,lllyliic

ma,s:s ,(arrows) ,an:siiio'g froID tbeliow,e!r

t:bora.ciic

,esop,1i ag us, Thle Ol'ass

Fi:gIIIr,e 30-1'1 Mali:gnant .s,p;iindlie,ceilIi to..'OIi' ,0,' 'th,e ,esioip,liIagu.s., "CT ~Sican~s,hIO'WSi'giiantp:o.:l~p,oii:diintr,allumiina:11 A ,a .D1:ass.(aTl'Owhe:adsj wi;tliil.h,o'Dl1og,en'emlls:so,ft fiissue alte,nu,atiio,D ~Thi:s , igh.tediiOl,age(:C'" I.es:iion iiishypoiintens:e,on Ti. -weiight,edbnalge (8" ,a.nd bete'li'ogeneou.s'liyhy.periinte'Qse tOnT2-wei After ,admiiniistr.afion IOf 'g.adol'iiniium-DT'P'A (0 the ,IJes:.i:ona'lTOwheadsJ ( show.s beteli'lOgen eOUSi,consiid,era.blie ,enh'anclem.eni., 'Tbe ,Iiesi:on doe,s not ca,us,e ,eslOp,ha'g,e.a'll obstnlcti:on d:es,pi't,eiits ,Ilali',g,es,i~e,.,
1 ',

F'i:gur,e30·'1. 2 E:sop,ha.g,ea~,ca'n,c,eriinvad,iing linedi!~;sfiinali fai.,eT :s,can d'eDlon.s,trates; 'ciin::uDller,entiiaII w,alll th:iickeniing of the di:stall ,es:op,ha:glls; (ano,wJ., 'Th,ep,eriiesop,ha:g,eali fa,ti;s, (,ep:I'aciedb1y SlotH ti:slslIe ,a.Hen,llI,a.tiioln. (arrowheads).,

F'ii:g ur,e3,O"·".3,E,s:o,,!ha.ge:a:11c'3.D:Cie.r wi,lh. b,alcheall'iiny,as.i'O.n~ 'CT .scan..s.howsc'iircuHller,e.n.tiiall waUl thi'ckeni:lil!g with the po's,'lieli;olir w,alll 'olf thie! b,ache,a (aTrows)"iilildic:ati:n:Q diil,e,cl elden.si:oniinlo, the ,I:ulillen,~
1

Qif the p!loJljiimalles1op,h,aig us ,(atTowJ1eads)" whi:chs,how.siin;e;gllllla.riintedacle

'Co'nc;avily that onliY tllJe ,coD,cayily

F'i:gul'ie ,3,0 ..14

'0"

tbep,ols,teri'o,r

tra~cli1ea.11 ¥II,alll Dl iiDliickiingiiny,as:i:o,n.,

iQlf ih,e tra.,ebea" wiithouts;urfa:ceiinegularily

.A:llhoU'gh th,ep,o!s,teri:o,r bachea'il walll ;ils,,c'o,nc:av,e' ,(arrow)"tbe surface or ,ap,par,ent ii!nt:ra1111iim.a DiI IIp,robu.s:i:on." doe,sn.g,t .suQ:Qies:t llJe iUliDori;nv,asiiion., t

'0"

tbepoistelii'(j,r

w,alli ,iis,SlOooth.,

Noi'e,

Fi:gure ·3.0-'1·5, Es,o'p'lIJ:a.gea'll,e,anc1e!rw,iith :ao,l11liic i:n.va,s:i;o,n.~ n ,a.r,e ,(b'e"t autJ'wJo,f A d,eg Irees"i:mdi'c:atiilllg ,a.oniic iin'vas:iion~

th,e'c1o'liliactbetwee!1Il

th·e ·es:o'p,ha,g,e!all ,c:a.n,c!er ,(aTTO'w§) ,and the ,a.o,rta ,(arrowheads) Is nlo,r,e tha n '90

F'i:gur,e3!OIo201 ESio'p,ha'giiilils;.,CT scan .slI!olw.s ,ciir,cuDller,entiiall ,a p,o:iint of d.iiBer1e!ut:iia.tiion lir(~rlill ,esoprh,ageall 'ciar'c;iinollna.,

,esioplha1geallwalll

thic~en:iing

with the, ''tar'g,et

.s:i'gnil' ,(aRDwlJeadsj., Th!e ,esio,p,ha1geall fatiisp,r,es!erv,ediin.

,esio,p,ha1giitils:,whic.h

ii:s

Fi'gu r,e3,Q1.2:1 F'iistul:a betweien th.,e ,eSio'p,ha'gus: ,and tuber,cu'l:ous, ,a.nd the ,en liarged s:mbc,alliin,alll!ylll1p,h node ,(culYed ,aUD ws).

,Iiymp,h,aden~o,p,athy,., ,CTs:ca,n d,e.olns,tr,at,es,

,an :aiir:.fUled. fi:s,tul~o!us tr,a,cil: ,(aRDws) betw,een,

the ,es'o,p,h,a'gu.s (arrlJwheads)

Ftg IIIli'ie30..;23, AchaI1a.s,iia.iin,a 47 ... i y,ear;.ol~dwoman., A" ,CTsc:a,lls:how,s

,oo'l11l1:",a,5·1 "iilh

p'5 eudo:acba,I'a.s:iia
I

dU1a.ted"fliui:d-fill~ed 'esopih.a!gus: ,ta1TlJw}., 8." 1111 thi:sp,a,tiell1t, the diistalle.sop,ha.g,eall wa'II' I:hi:ck:ness .(an-owJ :iis;n·o,rm.all,iin 'lti'l1lg fro,lO, ,eso'p,bao,e.aII ,c·anc1er,., r,es,u

Fiigu Ii',e·3:0 24 E,s,o,p,ha~geal! Y,ali"iicles.,A,Co,n.tIi'.a,st-en h,a.n~cled.CTslc;an that w,a,s .. pedonned ,aliteli' iai'li' iinsuftl1ation y,iia,'ca.tbeteli' p,11a:c1ed tbe up,p'eli' ,esop,hagU's .S,bOW5 ia, iin weU-e!n hanc:iing nodul!a Ii'I!esi:on ,(ar£o'wsj p'li'otli'udiingiinito th.,e ,llu•. ,en of the ,esop,bag us,
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