Usefulness of Barium Studies for Differentiating Benign and Malignant Strictures of the Esophagus
Sonya Gupta1,
Marc S. Levine1,
Stephen E. Rubesin1,
David A. Katzka2 and
Igor Laufer1
1 Department of Radiology, Hospital of the University of Pennsylvania, 3400
Spruce St., Philadelphia, PA 19104.
2 Department of Medicine, Hospital of the University of Pennsylvania,
Philadelphia, PA 19104.
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Fig. 1A. —67-year-old woman with peptic stricture that was judged to be
benign by observers. Left posterior oblique double-contrast esophagogram
obtained with patient upright shows benign-appearing stricture
(arrow) in distal esophagus. Note that stricture has smooth contour
and tapered borders.
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Fig. 1B. —67-year-old woman with peptic stricture that was judged to be
benign by observers. Right anterior oblique single-contrast esophagogram
obtained with patient prone shows smooth, tapered stricture (arrow)
in distal esophagus above hiatal hernia. Endoscopy (not shown) revealed peptic
stricture, and endoscopic biopsy specimens revealed no evidence of tumor.
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Fig. 2A. —57-year-old man with ringlike peptic stricture that was
judged to be benign by observers. Left posterior oblique double-contrast
esophagogram obtained with patient upright shows benign-appearing stricture as
smooth, symmetric ringlike constriction (arrow) with slightly tapered
borders at gastroesophageal junction. Note resemblance to Schatzki's ring.
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Fig. 2B. —57-year-old man with ringlike peptic stricture that was
judged to be benign by observers. Right anterior oblique single-contrast
esophagogram obtained with patient prone shows ringlike constriction
(arrow) above hiatal hernia. Endoscopy (not shown) revealed ringlike
peptic stricture, and endoscopic biopsy specimens revealed no evidence of
tumor.
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Fig. 3A. —53-year-old man with ringlike peptic stricture (seen only on
single-contrast esophagogram) that was judged to be benign by observers. Left
posterior oblique double-contrast esophagogram obtained with patient upright
shows no definite stricture, but distal esophagus is not optimally
distended.
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Fig. 3B. —53-year-old man with ringlike peptic stricture (seen only on
single-contrast esophagogram) that was judged to be benign by observers. Right
anterior oblique single-contrast esophagogram obtained with patient prone
shows benign-appearing ringlike stricture (arrow) at gastroesophageal
junction above hiatal hernia. Endoscopy (not shown) revealed short peptic
stricture, and endoscopic biopsy specimens revealed Barrett's esophagus
without evidence of tumor.
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Fig. 4. —62-year-old woman with midesophageal stricture that was
judged to be benign by observers. Left posterior oblique double-contrast
esophagogram obtained with patient upright shows benign-appearing stricture in
mid esophagus as concentric segment of narrowing (arrows) with smooth
contour and tapered borders. Endoscopy (not shown) also revealed
benign-appearing stricture in mid esophagus, and endoscopic biopsy specimens
revealed no evidence of tumor. Because patient had history of radiation
therapy for lung carcinoma, this stricture is presumed to have been radiation
induced. (Note surgical clips from prior left upper lobectomy.)
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Fig. 5. —71-year-old man with distal esophageal stricture that was
judged to be malignant by observers. Left posterior oblique double-contrast
esophagogram obtained with patient upright shows malignant-appearing stricture
(arrows) in distal esophagus. Narrowed segment has markedly irregular
contour with areas of nodularity and ulceration. Endoscopic biopsy specimens
revealed esophageal adenocarcinoma.
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Fig. 6. —55-year-old woman with peptic stricture that was judged to be
equivocal by observers. Left posterior oblique double-contrast esophagogram
obtained with patient upright shows that stricture (black arrows) in
distal esophagus has some benign features with tapered proximal margins and
some malignant features with irregular contour and tiny areas of ulceration
(white arrows). Endoscopy (not shown) revealed peptic stricture in
distal esophagus with associated reflux esophagitis, but endoscopic biopsy
specimens revealed no evidence of tumor.
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Fig. 7. —67-year-old man with peptic stricture that was judged to be
equivocal by observers. Left posterior oblique double-contrast esophagogram
obtained with patient upright shows that stricture (white arrow) in
distal esophagus has some benign features with tapered distal margins and some
malignant features with abrupt proximal margins (black arrows) and
marked asymmetry. Endoscopy (not shown) revealed benign peptic stricture in
distal esophagus, and endoscopic biopsy specimens revealed Barrett's esophagus
without evidence of tumor.
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Fig. 8. —58-year-old man with upper esophageal stricture that was
judged to be equivocal by observers. Right posterior oblique double-contrast
esophagogram obtained with patient upright shows that stricture (white
arrow) in upper esophagus has some benign features with tapered distal
margins and smooth contour and some malignant features with abrupt proximal
margins (black arrows). Endoscopy (not shown) revealed
malignant-appearing stricture in upper esophagus, but endoscopic biopsy
specimens could not be obtained because of degree of obstruction. This patient
was known to have undergone esophagogastrectomy for esophageal carcinoma;
therefore, endoscopic findings were attributed to recurrent or metachronous
carcinoma.
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Copyright © 2003 by the American Roentgen Ray Society.
