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CT of the Normal Esophagus to Define the Normal Air Column and Its Extent and Distribution

¹ Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, M/C 719, University of Illinois at Chicago, 840 S Wood St., Chicago, IL 60612-7323.
² Present address: Division of Pulmonary Medicine, Rochester General Hospital, Rochester, NY.
³ Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL.

OBJECTIVE. This study was designed to quantify and characterize the air-containing thoracic esophagus on CT to help diagnose diseases and facilitate correlation with lung diseases that may be associated with aspiration.

SUBJECTS AND METHODS. The maximal air-containing esophageal lumina on each section of standard CT scans of 110 subjects were measured. These subjects came from a cohort of 10,132 self-reported healthy individuals who underwent CT for measurement of coronary artery calcium. Measurements were interpolated to account for variation in the length of the thoraces.

RESULTS. Greater than 60% of the esophageal segments contained no air. On average the maximum air column was 10.5 (SD, 5.0) mm. Only 7.9% of the lumina were > 10 mm. Only 2% were > 15 mm, and only 0.2% were > 20 mm. The average number of lumina > 10 mm as a proportion of the entire esophageal length was 8% (14%). The average size at the carina was 2.6 (4.1) mm. In the upper 30% and from 61% to 75% down the length of the esophagus, < 5% of the lumina were > 10 mm. Less than 3% of subjects had air in the lowest two sections, indicating that the normal lower esophageal sphincter was closed.

CONCLUSION. Esophageal air of > 10 mm should be considered abnormal in all segments except between the cardiac ventricles and lower esophageal sphincter. In this area, > 15 mm should be considered abnormal. An air–fluid level is abnormal.

Keywords: chest CT • esophagus • normal • radiographic anatomy

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