Esophageal Stents: Findings on Esophagography in 46 Patients
Gregory S. Anderson1,
Marc S. Levine1,
Stephen E. Rubesin1,
Igor Laufer1,
Gregory G. Ginsberg2 and
Michael L. Kochman2
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.
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Fig. 1A —80-year-old woman with stent placed for palliation of
dysphagia caused by squamous cell carcinoma of esophagus. Left posterior
oblique scout image shows tapered narrowing (arrows) of midportion of
stent.
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Fig. 1B —80-year-old woman with stent placed for palliation of
dysphagia caused by squamous cell carcinoma of esophagus. Left posterior
oblique spot image from single-contrast esophagram shows tapered narrowing of
barium column (arrows) where lumen and stent are compressed by
surrounding esophageal tumor.
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Fig. 2 —70-year-old man with stent placed for palliation of dysphagia
caused by advanced malignant tumor of uncertain origin involving upper
thoracic esophagus. Left posterior oblique spot image from single-contrast
esophagram shows barium (arrows) flowing around left anterolateral
wall of proximal end of stent.
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Fig. 3 —75-year-old man with stent placed for palliation of dysphagia
caused by adenocarcinoma of distal esophagus invading gastric cardia and
fundus. Steep right posterior oblique spot image from single-contrast
esophagram shows narrowing and kinking of stent (black arrow) by
surrounding tumor in distal esophagus. Note how stent traverses
gastroesophageal junction with distal end (white arrow) in gastric
fundus.
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Fig. 4A —60-year-old man with stent placed for palliation of dysphagia
caused by squamous cell carcinoma of esophagus. Steep right posterior oblique
spot image from single-contrast esophagram shows apparent narrowing of distal
esophagus (arrows) from distal end of stent to gastroesophageal
junction.
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Fig. 4B —60-year-old man with stent placed for palliation of dysphagia
caused by squamous cell carcinoma of esophagus. Frontal spot image from same
examination as A shows barium trapped between gastric folds of
incompletely filled hiatal hernia (arrows). Subsequent endoscopy
confirmed presence of hiatal hernia in this patient.
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Fig. 5 —55-year-old man with stent placed for palliation of dysphagia
caused by squamous cell carcinoma of esophagus. Left posterior oblique spot
image from single-contrast esophagram shows asymmetric mass effect
(arrows) on right posterolateral wall of distal esophagus abutting
stent. This finding was caused by tumor overgrowth into distal end of
stent.
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Fig. 6 —53-year-old man with stent placed for palliation of dysphagia
caused by malignant tumor of uncertain origin encasing mid esophagus. Right
posterior oblique spot image from single-contrast esophagram shows focal
segment of marked luminal narrowing (black arrows) in distal end of
stent. Note irregular contour and abrupt, shelflike distal margins (white
arrows) of narrowed segment. At endoscopy, this finding was caused by
tumor ingrowth through uncovered distal end of stent.
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Fig. 7 —71-year-old woman with stent placed for palliation of
carcinoma of lung invading upper thoracic esophagus. Right posterior oblique
spot image from single-contrast esophagram shows narrowing of lumen
(arrows) in distal end of stent. Note relatively smooth contour and
tapered margins of narrowed segment. Endoscopic biopsy specimens from this
region revealed epithelial hyperplasia. (Note pneumomediastinum and
subcutaneous emphysema in soft tissues of neck from esophageal perforation
that occurred during endoscopic dilatation procedure before placement of
stent.)
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Fig. 8 —79-year-old man with stent placed for palliation of
tracheoesophageal fistula caused by squamous cell carcinoma of esophagus. Left
posterior oblique spot image from single-contrast esophagram shows irregular
luminal narrowing (white arrows) in distal end of stent. Also note
barium in left mainstem bronchus (black arrows) from
esophagobronchial fistula that presumably developed as a result of tumor
ingrowth through adjacent uncovered distal portion of stent.
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Fig. 9A —62-year-old man with stent placed for palliation of dysphagia
caused by carcinoma of gastric cardia invading distal esophagus. Left
posterior oblique spot image from single-contrast esophagram shows distal
migration of stent (white arrows) into gastric fundus. Note barium in
distal esophagus (black arrows).
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Fig. 9B —62-year-old man with stent placed for palliation of dysphagia
caused by carcinoma of gastric cardia invading distal esophagus. Malpositioned
stent was removed, and a new stent was placed across gastroesophageal
junction. Repeat examination 1 day after first study shows proper positioning
of new stent (black arrows) with proximal half in distal esophagus
and distal half in proximal stomach. Note how distal end of stent (large
white arrow) directly abuts greater curvature of proximal stomach.
Despite this finding, patient's dysphagia was adequately palliated by stent.
Polypoid carcinoma (small white arrows) is seen at gastroesophageal
junction.
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Copyright © 2006 by the American Roentgen Ray Society.
