Dysphagia pp 281-299 | Cite as

Morphology of the Esophagus

  • Marc S. Levine
  • Arastoo Vossough
Part of the Medical Radiology book series (MEDRAD)


Barium esophagography is an invaluable radiologic technique for detecting a host of morphologic abnormalities in the esophagus. Double-contrast barium studies are particularly well suited for diagnosing reflux esophagitis and its complications, including peptic strictures and Barrett’s esophagus. Double-contrast esophagography is also useful for detecting infectious esophagitis and for differentiating the underlying causes, including Candida albicans, the herpes simplex virus, cytomegalovirus, and human immunodeficiency virus. Barium studies can also facilitate the diagnosis of drug-induced esophagitis, eosinophilic esophagitis, and other less common forms of esophagitis. In patients with dysphagia, barium esophagography is a sensitive test for detecting the two common malignant tumors of the esophagus—squamous cell carcinoma and adenocarcinoma. Finally, esophagography can be used to diagnose other morphologic abnormalities in the esophagus, including webs, rings, diverticula, varices, foreign body impactions, fistulas, and perforation. All of these conditions are discussed in the following chapter.


Reflux Esophagitis Distal Esophagus Granular Cell Tumor Duplication Cyst Epiphrenic Diverticulum 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Agha FP, Keren DF (1985) Spindle-cell squamous carcinoma of the esophagus: a tumor with biphasic morphology. AJR Am J Roentgenol 145:541–545PubMedGoogle Scholar
  2. Appelqvist P, Salmo M (1980) Lye corrosion carcinoma of the esophagus: a review of 63 cases. Cancer 45:2655–2658PubMedCrossRefGoogle Scholar
  3. Banfield WJ, Hurwitz AL (1974) Esophageal stricture associated with nasogastric intubation. Arch Intern Med 134:1083–1086PubMedCrossRefGoogle Scholar
  4. Barber GB, Peppercorn MA, Ehrlich C et al (1984) Esophageal foreign body perforation: report of an unusual case and review of the literature. Am J Gastroenterol 79:509–511PubMedGoogle Scholar
  5. Baron RL, Koehler RE, Gutierrez FR et al (1981) Clinical and radiographic manifestations of aortesophageal fistulas. Radiology 141:599–605PubMedGoogle Scholar
  6. Bleshman MH, Banner MP, Johnson RC et al (1978) The inflammatory esophagogastric polyp and fold. Radiology 128:589–593PubMedGoogle Scholar
  7. Bova JG, Dutton NE, Goldstein HM et al (1987) Medication-induced esophagitis: diagnosis by double-contrast esophagography. AJR Am J Roentgenol 148:731–732PubMedGoogle Scholar
  8. Buecker A, Wein BB, Neuerburg JM et al (1997) Esophageal perforation: comparison of use of aqueous and barium-containing contrast media. Radiology 202:683–686PubMedGoogle Scholar
  9. Carlyle DR, Goldstein HM, Wallace S et al (1976) Azygography in the pre-treatment evaluation of esophageal carcinoma. Br J Radiol 49:670–677PubMedCrossRefGoogle Scholar
  10. Carnovale RL, Goldstein HM, Zornoza J et al (1977) Radiologic manifestations of esophageal lymphoma. AJR Am J Roentgenol 128:751–754PubMedGoogle Scholar
  11. Carter R, Brewer LA III (1975) Achalasia and esophageal carcinoma. Studies in early diagnosis for improved surgical management. Am J Surg 130:114–120PubMedCrossRefGoogle Scholar
  12. Chen YM, Ott DJ, Gelfand DW et al (1985) Multiphasic examination of the esophagogastric region for strictures, rings, and hiatal hernia: evaluation of the individual techniques. Gastrointest Radiol 10:311–316PubMedCrossRefGoogle Scholar
  13. Chen YM, Gelfand DW, Ott DJ et al (1987) Natural progression of the lower esophageal mucosal ring. Gastrointest Radiol 12:93–98PubMedCrossRefGoogle Scholar
  14. Cockerill EM, Miller RE, Chernish SM et al (1976) Optimal visualization of esophageal varices. Am J Roentgenol 126:512–523Google Scholar
  15. Collazzo LA, Levine MS, Rubesin SE et al (1997) Acute radiation esophagitis: radiographic findings. AJR Am J Roentgenol 169:1067–1070PubMedGoogle Scholar
  16. Creteur V, Laufer I, Kressel HY et al (1983a) Drug-induced esophagitis detected by double-contrast radiography. Radiology 147:365–368PubMedGoogle Scholar
  17. Creteur V, Thoeni RF, Federle MP et al (1983b) The role of single and double-contrast radiography in the diagnosis of reflux esophagitis. Radiology 147:71–75PubMedGoogle Scholar
  18. Dafoe CS, Ross CA (1969) Acute corrosive esophagitis. Thorax 24:291–294PubMedCrossRefGoogle Scholar
  19. DiPalma JA, Prechter GC, Brady CE 3rd (1984) X-ray-negative dysphagia: is endoscopy necessary? J Clin Gastroenterol 6:409–411PubMedCrossRefGoogle Scholar
  20. Ekberg O, Nylander G (1983) Webs and web-like formations in the pharynx and cervical esophagus. Diagn Imaging 52:10–18PubMedGoogle Scholar
  21. Fitzgerald RH Jr, Bartles DM, Parker EF (1981) Tracheoesophageal fistulas secondary to carcinoma of the esophagus. J Thorac Cardiovasc Surg 82:194–197PubMedGoogle Scholar
  22. Gefter WB, Laufer I, Edell S et al (1981) Candidiasis in the obstructed esophagus. Radiology 138:25–28PubMedGoogle Scholar
  23. Gershwind ME, Chiat H, Addei KA et al (1978) Granular cell tumors of the esophagus. Gastrointest Radiol 2:327–330PubMedCrossRefGoogle Scholar
  24. Gilchrist AM, Levine MS, Carr RF et al (1988) Barrett’s esophagus: diagnosis by double-contrast esophagography. AJR Am J Roentgenol 150:97–102PubMedGoogle Scholar
  25. Glanz I, Grunebaum M (1977) The radiological approach to leiomyoma of the esophagus with a long-term follow-up. Clin Radiol 28:197–200PubMedCrossRefGoogle Scholar
  26. Glick SN, Teplick SK, Goldstein J et al (1982) Glycogenic acanthosis of the esophagus. AJR Am J Roentgenol 139:683–688PubMedGoogle Scholar
  27. Glick SN, Teplick SK, Levine MS et al (1986) Gastric cardia metastasis in esophageal carcinoma. Radiology 160:627–630PubMedGoogle Scholar
  28. Gloyna RE, Zornoza J, Goldstein HM (1977) Primary ulcerative carcinoma of the esophagus. AJR Am J Roentgenol 129:599–600PubMedGoogle Scholar
  29. Goldstein HM, Rogers LF, Fletcher GH et al (1975) Radiological manifestations of radiation-induced injury to the normal upper gastrointestinal tract. Radiology 117:135–140PubMedGoogle Scholar
  30. Goldstein HM, Zornoza J, Hopens T (1981) Intrinsic diseases of the adult esophagus: benign and malignant tumors. Semin Roentgenol 16:183–197PubMedCrossRefGoogle Scholar
  31. Graham J, Barnes M, Rubenstein AS (1959) The nasogastric tube as a cause of esophagitis and stricture. Am J Surg 98:116–199PubMedCrossRefGoogle Scholar
  32. Haulk AA, Sugar AM (1991) Candida esophagitis. Adv Intern Med 36:307–318PubMedGoogle Scholar
  33. Hollander JE, Quick G (1991) Aortesophageal fistula: a comprehensive review of the literature. Am J Med 91:279–287PubMedCrossRefGoogle Scholar
  34. Hu C, Levine MS, Laufer I (1997) Solitary ulcers in reflux esophagitis: radiographic findings. Abdom Imaging 22:5–7PubMedCrossRefGoogle Scholar
  35. Johnston J, Helwig EB (1981) Granular cell tumors of the gastrointestinal tract and perianal region: a study of 74 cases. Dig Dis Sci 26:807–816PubMedCrossRefGoogle Scholar
  36. Kressel HY, Glick SN, Laufer I et al (1981) Radiologic features of esophagitis. Gastrointest Radiol 6:103–108PubMedCrossRefGoogle Scholar
  37. Laufer I (1982) Radiology of esophagitis. Radiol Clin North Am 20:687–699PubMedGoogle Scholar
  38. Levine MS (1994) Reflux esophagitis and Barrett’s esophagus. Semin Roentgenol 29:332–340PubMedCrossRefGoogle Scholar
  39. Levine MS (2000a) Infectious Esophagitis. In: Gore RM, Levine MS (eds) Textbook of gastrointestinal radiology, 2nd edn. W.B. Saunders, Philadelphia, pp 350–363Google Scholar
  40. Levine MS (2000b) Miscellaneous abnormalities of the esophagus. In: Gore RM, Levine MS (eds) Textbook of gastrointestinal radiology, 2nd edn. W.B. Saunders, Philadelphia, pp 465–483Google Scholar
  41. Levine MS, Goldstein HM (1984) Fixed transverse folds in the esophagus: a sign of reflux esophagitis. AJR Am J Roentgenol 143:275–278PubMedGoogle Scholar
  42. Levine MS, Halvorsen RA (2000) Carcinoma of the esophagus. In: Gore RM, Levine MS (eds) Textbook of gastrointestinal radiology, 2nd edn. W.B. Saunders, Philadelphia, pp 403–434Google Scholar
  43. Levine MS, Laufer I, Kressel HY et al (1981) Herpes esophagitis. AJR Am J Roentgenol 136:863–866PubMedGoogle Scholar
  44. Levine MS, Kressel HY, Caroline DF et al (1983) Barrett esophagus: reticular pattern of the mucosa. Radiology 147:663–667PubMedGoogle Scholar
  45. Levine MS, Caroline D, Thompson JJ et al (1984) Adenocarcinoma of the esophagus: relationship to Barrett mucosa. Radiology 150:305–309PubMedGoogle Scholar
  46. Levine MS, Macones AJ Jr, Laufer I (1985) Candida esophagitis: accuracy of radiographic diagnosis. Radiology 154:581–587PubMedGoogle Scholar
  47. Levine MS, Dillon EC, Saul SH et al (1986) Early esophageal cancer. AJR Am J Roentgenol 146:507–512PubMedGoogle Scholar
  48. Levine MS, Woldenberg R, Herlinger H et al (1987) Opportunistic esophagitis in AIDS: radiographic diagnosis. Radiology 165:815–820PubMedGoogle Scholar
  49. Levine MS, Loevner LA, Saul SH et al (1988) Herpes esophagitis: sensitivity of double-contrast esophagography. AJR Am J Roentgenol 151:57–62PubMedGoogle Scholar
  50. Levine MS, Fisher AR, Rubesin SE et al (1991a) Complications after total gastrectomy and esophagojejunostomy: radiologic evaluation. AJR Am J Roentgenol 157:1189–1194PubMedGoogle Scholar
  51. Levine MS, Loercher G, Katzka DA et al (1991b) Giant, human immunodeficiency virus-related ulcers in the esophagus. Radiology 180:323–326PubMedGoogle Scholar
  52. Levine MS, Herman JB, Furth EE (1995) Barrett’s esophagus and esophageal adenocarcinoma: the scope of the problem. Abdom Imaging 20:291–298PubMedCrossRefGoogle Scholar
  53. Levine MS, Buck JL, Pantongrag-Brown L et al (1996) Fibrovascular polyps of the esophagus: clinical, radiographic, and pathologic findings in 16 patients. AJR Am J Roentgenol 166:781–787PubMedGoogle Scholar
  54. Levine MS, Chu P, Furth EE et al (1997) Carcinoma of the esophagus and esophagogastric junction: sensitivity of radiographic diagnosis. AJR Am J Roentgenol 168:1423–1426PubMedGoogle Scholar
  55. Little AG, Ferguson MK, DeMeester TR et al (1984) Esophageal carcinoma with respiratory tract fistula. Cancer 53:1322–1328PubMedCrossRefGoogle Scholar
  56. Livingston EM, Skinner DB (1985) Tumors of the Esophagus. In: Berk JE (ed) Gastroenterology. W.B. Saunders, Philadelphia, pp 818–850Google Scholar
  57. Macpherson RI (1993) Gastrointestinal tract duplications: clinical, pathologic, etiologic, and radiologic considerations. RadioGraphics 13:1063–1080PubMedGoogle Scholar
  58. Miller BJ, Murphy F, Lukie BE (1978) Squamous cell papilloma of esophagus. Can J Surg 21:538–540PubMedGoogle Scholar
  59. Nandi P, Ong GB (1978) Foreign body in the esophagus: review of 2394 cases. Br J Surg 65:5–9PubMedCrossRefGoogle Scholar
  60. O’Connell ND (1967) Spontaneous rupture of the esophagus. Am J Roentgenol Radium Ther Nucl Med 99:186–203PubMedGoogle Scholar
  61. Parkin GJ (1973) The radiology of perforated esophagus. Clin Radiol 24:324–332PubMedCrossRefGoogle Scholar
  62. Pera M, Cameron AJ, Trastek VF et al (1993) Increasing incidence of adenocarcinoma of the esophagus and esophagogastric junction. Gastroenterology 104:510–513PubMedGoogle Scholar
  63. Pope CE (1994) Acid-reflux disorders. N Engl J Med 331:656–660PubMedCrossRefGoogle Scholar
  64. Rafal RB, Markisz JA (1991) Magnetic resonance imaging of an esophageal duplication cyst. Am J Gastroenterol 86:1809–1811PubMedGoogle Scholar
  65. Robbins AH, Vincent ME, Saini M et al (1978) Revised radiologic concepts of the Barrett esophagus. Gastrointest Radiol 3:377–381PubMedCrossRefGoogle Scholar
  66. Rubesin S, Herlinger H, Sigal H (1985) Granular cell tumors of the esophagus. Gastrointest Radiol 10:11–15PubMedCrossRefGoogle Scholar
  67. Ryan JM, Kelsey P, Ryan BM et al (1998) Alendronate-induced esophagitis: case report of a recently recognized form of severe esophagitis with esophageal stricture––radiographic features. Radiology 206:389–391PubMedGoogle Scholar
  68. Sam JW, Levine MS, Rubesin SE et al (2000) The “foamy” esophagus: a radiographic sign of Candida esophagitis. AJR Am J Roentgenol 174:999–1002PubMedGoogle Scholar
  69. Sandvik AK, Aase S, Kveberg KH et al (1996) Papillomatosis of the esophagus. J Clin Gastroenterol 22:35–37PubMedCrossRefGoogle Scholar
  70. Schatzki R (1963) The lower esophageal ring. Long term follow-up of symptomatic and asymptomatic rings. Am J Roentgenol 90:805Google Scholar
  71. Schatzki R, Gary JE (1956) The lower esophageal ring. AJR Am J Roentgenol 75:246Google Scholar
  72. Seremetis MG, Lyons WS, deGuzman VC et al (1976) Leiomyomata of the esophagus. An analysis of 838 cases. Cancer 38:2166–2177PubMedCrossRefGoogle Scholar
  73. Shortsleeve MJ, Levine MS (1992) Herpes esophagitis in otherwise healthy patients: clinical and radiographic findings. Radiology 182:859–861PubMedGoogle Scholar
  74. Sor S, Levine MS, Kowalski TE et al (1995) Giant ulcers of the esophagus in patients with human immunodeficiency virus: clinical, radiographic, and pathologic findings. Radiology 194:447–451PubMedGoogle Scholar
  75. Spechler SJ, Robbins AH, Rubins HB et al (1984) Adenocarcinoma and Barrett’s esophagus. an overrated risk? Gastroenterology 87:927–933PubMedGoogle Scholar
  76. Swanson JO, Levine MS, Redfern RO, Rubesin SE (2003) Usefulness of high-density barium for detection of leaks after esophagogastrectomy, total gastrectomy, and total laryngectomy. AJR Am J Roentgenol 181:415–420PubMedGoogle Scholar
  77. Takashima S, Takeuchi N, Shiozaki H et al (1991) Carcinoma of the esophagus: CT versus MR imaging in determining resectability. AJR Am J Roentgenol 156:297–302PubMedGoogle Scholar
  78. Taylor AJ, Stewart ET, Dodds WJ (1990) The esophageal “jet” phenomenon revisited. AJR Am J Roentgenol 155:289–290PubMedGoogle Scholar
  79. Totten R, Stout AP, Humphreys GH (1953) Benign tumors and cysts of the esophagus. J Thorac Surg 25:606–622PubMedGoogle Scholar
  80. Underberg-Davis S, Levine MS (1991) Giant thoracic osteophyte causing esophageal food impaction. AJR Am J Roentgenol 157:319–320PubMedGoogle Scholar
  81. Vasquez RE, Landay M, Kilman WJ et al (1988) Benign esophagorespiratory fistulas in adults. Radiology 167:93–96PubMedGoogle Scholar
  82. Vilgrain V, Mompoint D, Palazzo L et al (1990) Staging of esophageal carcinoma: comparison of results with endoscopic sonography and CT. AJR Am J Roentgenol 155:277–281PubMedGoogle Scholar
  83. White CS, Templeton PA, Attar S (1993) Esophageal perforation: CT findings. AJR Am J Roentgenol 160:767–770PubMedGoogle Scholar
  84. White SB, Levine MS, Rubesin SE et al (2010) The small-caliber esophagus: radiographic sign of idiopathic eosinophilic esophagitis. Radiology 256:127–134PubMedCrossRefGoogle Scholar
  85. Whitman GJ, Borkowski GP (1989) Giant fibrovascular polyp of the esophagus: CT and MR findings. AJR Am J Roentgenol 152:518–520PubMedGoogle Scholar
  86. Yamamoto AJ, Levine MS, Katzka DA et al (2001) Short-segment Barrett’s esophagus: findings on double-contrast esophagography in 20 patients. AJR Am J Roentgenol 176:1173–1178PubMedGoogle Scholar
  87. Zeabart LE, Fabian J, Nord HJ (1979) Squamous papilloma of the esophagus: a report of 3 cases. Gastrointest Endosc 25:18–20PubMedCrossRefGoogle Scholar
  88. Zimmerman SL, Levine MS, Rubesin SE et al (2005) Idiopathic eosinophilic esophagitis in adults: the ringed esophagus. Radiology 236:159–165PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.Department of RadiologyHospital of the University of PennsylvaniaPhiladelphiaUSA

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