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Diffuse Esophageal Spasm: CT Findings in Seven Patients

¹ All authors: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.

View larger version (88K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —55-year-old man with diffuse esophageal spasm and dysphagia. Single-contrast prone right anterior oblique esophagram shows diffuse esophageal spasm with marked (nearly lumen-obliterating) nonperistaltic contractions (white arrows) and narrowing of distal esophagus (small black arrow) due to incomplete opening of lower esophageal sphincter. Large black arrow denotes small hiatal hernia.

View larger version (73K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —55-year-old man with diffuse esophageal spasm and dysphagia. Contrast-enhanced axial CT scan at level of aortic arch shows moderate smooth symmetric thickening (arrow) of esophageal wall. Mediastinal goiter with mass effect on trachea and esophagus is partially depicted.

View larger version (68K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —55-year-old man with diffuse esophageal spasm and dysphagia. Axial CT scan at level of carina shows greater but still symmetric esophageal wall thickening (arrow) at this level.

View larger version (76K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —55-year-old man with diffuse esophageal spasm and dysphagia. Axial CT scan 5 cm above gastroesophageal junction shows greatest degree of esophageal wall thickening (arrow) at this level, although thickened wall is still smooth and symmetric.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —60-year-old man with diffuse esophageal spasm and dysphagia. Single-contrast prone right anterior oblique esophagram shows diffuse esophageal spasm with marked nonperistaltic contractions (black arrows) and short segment of tapered narrowing in distal esophagus (small white arrow) due to incomplete opening of lower esophageal sphincter. Large white arrow denotes small hiatal hernia.

View larger version (56K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —60-year-old man with diffuse esophageal spasm and dysphagia. Unenhanced axial CT scan near level of aortic arch shows moderate smooth symmetric thickening (arrow) of esophageal wall at this level.

View larger version (63K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —60-year-old man with diffuse esophageal spasm and dysphagia. Axial CT scan at level of carina shows moderate relatively symmetric esophageal wall thickening (arrow) at this level.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —60-year-old man with diffuse esophageal spasm and dysphagia. Axial CT scan 5 cm above gastroesophageal junction shows greatest degree of esophageal wall thickening (arrow) at this level, although thickened wall is still smooth and symmetric. As shown in Figures 1A, 1B, 1C, 1D and 2A, 2B, 2C, 2D, a relatively long segment of smooth, circumferential wall thickening in lower half of thoracic esophagus is characteristic of diffuse esophageal spasm on CT.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —72-year-old man with diffuse esophageal spasm but no dysphagia who was only patient in study with asymmetric wall thickening of lower thoracic esophagus. Single-contrast prone right anterior oblique esophagram shows diffuse esophageal spasm with moderate nonperistaltic contractions (black arrows) and tapered narrowing of distal esophagus (small white arrow) due to incomplete opening of lower esophageal sphincter. Large white arrow denotes small hiatal hernia.

View larger version (62K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —72-year-old man with diffuse esophageal spasm but no dysphagia who was only patient in study with asymmetric wall thickening of lower thoracic esophagus. Contrast-enhanced axial CT scan near level of aortic arch shows moderate smooth symmetric thickening (arrow) of esophageal wall at this level.

View larger version (47K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —72-year-old man with diffuse esophageal spasm but no dysphagia who was only patient in study with asymmetric wall thickening of lower thoracic esophagus. Axial CT scan at level of carina shows nodular asymmetric esophageal wall thickening (arrow) at this level.

View larger version (66K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —72-year-old man with diffuse esophageal spasm but no dysphagia who was only patient in study with asymmetric wall thickening of lower thoracic esophagus. Axial CT scan 5 cm above gastroesophageal junction shows greatest degree of esophageal wall thickening (arrow) at this level with considerable nodularity and asymmetry of thickened wall.

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