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Intramural Tracking

A Feature of Esophageal Intramural Pseudodiverticulosis

Cheri L. Canon1, Marc S. Levine2, Ravi Cherukuri2,3, Lawrence F. Johnson4, J. Kevin Smith1 and Robert E. Koehler1

1 Department of Radiology, University of Alabama at Birmingham, 619 S. 19th St., Birmingham, AL 35249-6830.
2 Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.
3 Present address: Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15206.
4 Department of Medicine, Division of Gastroenterology, University of Alabama at Birmingham, Birmingham, AL 35249.



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  		Fig. 1A. —58-year-old woman with reflux disease, dysphagia, and failed Nissen fundoplication. Double-contrast esophagram reveals mild corrugated stricture (curved arrow) of distal esophagus. Extending from stricture are tiny pseudodiverticula, with thin interconnecting intramural tracks (straight arrows).

 


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  		Fig. 1B. —58-year-old woman with reflux disease, dysphagia, and failed Nissen fundoplication. Esophagram also using high-density barium obtained 6 months after A shows marked progression of esophageal stricture (curved arrows). Note greater number of pseudodiverticula and tracks (straight arrows).

 


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  		Fig. 2A. —17-year-old boy with reflux disease and dysphagia. Double-contrast esophagram reveals 7-cm intramural track (black arrows) seen obliquely in mid esophagus. This track was initially misdiagnosed as giant flat ulcer. Scattered pseudodiverticula (white arrows) are seen throughout esophagus.

 


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  		Fig. 2B. —17-year-old boy with reflux disease and dysphagia. Single-contrast esophagram obtained 3 years before A shows same track in profile (arrows). Pseudodiverticula are not apparent on this study.

 


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  		Fig. 3. —75-year-old asymptomatic woman. Double-contrast esophagram shows smooth stricture in mid esophagus. Note pseudodiverticula are present in mid and distal esophagus. Both thin (open arrow) and thick (closed arrow) tracks are seen in region of stricture.

 


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  		Fig. 4A. —71-year-old asymptomatic man with diabetes. Double-contrast esophagram shows diffuse esophageal intramural pseudodiverticulosis with short intramural tracks bridging two pseudodiverticula (arrows).

 


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  		Fig. 4B. —71-year-old asymptomatic man with diabetes. Follow-up double-contrast esophagram obtained 4 years after A shows resolution of tracking and pseudodiverticula. Note peptic stricture (arrow) in distal esophagus near gastroesophageal junction.

 

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