GI Endoscopy Atlas: Gatstrointestinal Imaging

CT Findings in Esophageal Diseases

Peer Review Status: Internally Peer Reviewed
Creation Date: May 1998
Last Revision Date: February 2002

In healthy individuals, the esophagus can be seen as a small structure in the posterior mediastinum (figure 1). It normally collapses, although traces of enteric contrast may allow the identification of the lumen (figure 2). An air or contrast filled, dilated esophagus suggests distal obstruction (figure 3). This may be due to neoplasms (figure 4 & figure 5), motility disorders (figure 6) or extraluminal structures, such as lymph nodes (figure 7).

CT scans play an important role in the staging of esophageal malignancies. Cancer may lead to symmetrical wall thickening of the esophageal wall (figure 8). In earlier stages, the primary focus may be seen as polypoid structure or partial wall thickening (figure 9). The main indication for CT scanning is the detection of regional lymph node or distant metastases (figure 10). However, lymphadenopathy is not recognized by CT in up to 40 % of patients with esophageal carcinoma.

If there is strong suspicion for esophageal injury, CT scans may have a higher sensitivity demonstrating small tears compared to conventional contrast studies. Other esophageal changes may be seen incidentally, when patients are evaluated for other causes (figure 11, figure 12, figure 13).

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