Image Based Questions On Oesophagus

Diagnosis: Congenital Diaphragmatic Hernia 

You can notice presence of multiple bowel loop in the le side of thorax with shift of mediastinum to opposite side. M/C type of CDH is Bochdalek Hernia – Left Sided.

In the below X-ray you can see coiling of Ryle's tube in stomach and stomach is located at the thorax which is Diagnostic of congenital Diaphragmatic Hernia.

The Image Shows Different Types Of Hiatus Hernia

Type I – Sliding hernia, M/C type · Type II – True Paraoesophageal hernia, you can see herniation of fundus, but GE junction is normal · Type III – Mixed Paraoesophageal hernia, herniation of fundus and GE junction · Type IV – Paraoesophageal hernia containing intraabdominal organ other than stomach · M/C type of a Paraoesophageal hernia is Mixed or Type III.

Below Radiological Image Shows Type III PEH

The Image shows different type of fundoplication :

Watsons: 90° Anterior. DOR: 180° Anterior · Toupet: 270° Posterior · Belsey mark IV: 270° Anterior · Nissen's: 360°, Overall M/C performed.

Diagnosis: Barium Swallow Image Of Zenker's Diverticulum 

M/C type of Esophageal Diverticulum · Pseudo diverticula · It is a Pulsion diverticula, only herniation of mucosa and submucosa via Killian's dehiscence.

Below Radiological image shows epiphrenic diverticulum and mid-esophageal diverticulum o Epiphrenic diverticulum: It is a false diverticulum because it contains only mucosa and submucosa o Mid-esophageal diverticulum: Located in the middle part of esophagus - Aka Traction diverticulum - Only True esophageal diverticulum.

Below image shows Pathophysiology of Tracon diverticulum o In TB and Histoplasmosis there is inflammation of lymph nodes leading to fibrosis and contraction which pulls the wall of esophagus leading to traction diverticulum.

Image Shows Mega Esophagus 

Here esophagus is dilated, tortuous, loses its tone and looks like sigmoid esophagus · It is seen in Chronic Achalasia.

Diagnosis: Leiomyoma 

Can see smooth punched out filling defect · It is the most common benign tumor of esophagus · TOC: Enucleation.

Also Read: Biliary Tree Pathophysiology & Investigations

Diagnosis: Endoscopic Image of Barret Esophagus 

Can see red, velvety mucosa [columnar epithelium] along with pale squamous epithelium is between – Columnar metaplasia · Risk factor for Barret esophagus → Chronic GERD · Barret esophagus is risk factor for Adenocarcinoma esophagus · Diagnosed by Endoscopy and Biopsy.

Diagnosis: Carcinoma Esophagus 

On barium swallow apple core appearance suggestive of Carcinoma esophagus · On barium enema Apple core appearance suggestive of Carcinoma colon.

Diagnosis: Schatzki Ring

Concentric symmetrical narrowing at GE junction · Composed of mucosa and submucosa · On barium swallow also you can see concentric narrowing.

Diagnosis: Eosinophilic Esophagis 

aka Trachializaon of esophagus · Given endoscopy shows series of stacked mucosal rings suggestive of eosinophilic esophagis · Characteristic appearance: On barium swallow due to contraction of muscularis mucosa you can see fine transverse striaon k/a Feline esophagus · Feline esophagus is also seen in chronic GERD.

Diagnosis: Esophageal Candidiasis 

On endoscopy you can see diffused plaque material coating the esophagus mucosa · Shaggy appearance of mucosal defect on Barium swallow.

Also read: High-Yield GIT, Hepatobiliary and Pancreatic Surgery Questions

Hope you found this blog helpful for your GIT, Hepatobiliary and Pancreatic Surgery preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.