Case 41 - Esophageal mural thickening

Summary

Imaging description

Esophageal mural thickening is a nonspecific finding by CT chest. Mural thickening may be diffuse, segmental, or focal. It may occur in any segment of the esophagus, although it is more common distally. Intravenous contrast material administration is helpful in the CT evaluation of esophageal mural thickening. Esophagitis is more likely than esophageal carcinoma when uniform, circumferential mural thickening involves a long segment of the esophagus (Figure 41.1) [1]. Esophageal carcinoma is more likely when irregular, asymmetric mural thickening involves a short segment of the esophagus (Figure 41.2). Lymphadenopathy supports the diagnosis of esophageal cancer. Cancers of the mid and upper esophagus typically metastasize to paratracheal lymph nodes; cancers of the lower esophagus typically spread to gastrohepatic ligament lymph nodes [2].

Importance

Esophageal mural thickening is never a normal finding. Since mural thickening is not easily diagnosed by esophagram or by endoscopy, it is important that it be included in the CT chest report. Accurate description of the esophageal mural thickening will encourage referring physicians to consider infection, inflammation, and neoplasm – rather than fibrotic stricture or abnormal motility – as the cause of any dysphagia reported by the patient. Over the last decade, eosinophilic esophagitis has gained greater recognition as a cause of esophagitis (Figure 41.3) [3].