3 Extrinsic Impressions on the Thoracic Esophagus

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig GI 3-1 Normal esophageal impressions caused by the aorta (short arrow) and left main-stem bronchus (long arrow).

• Fig GI 3-2 Right aortic arch.

• Fig GI 3-3 Dysphagia aortica. Tortuosity of the descending thoracic aorta produces characteristic displacement of the esophagus to the left. Note the retraction of the upper esophagus to the right, caused by chronic inflammatory disease, which simulates an extrinsic mass arising from the opposite side.

• Fig GI 3-4 Aberrant left pulmonary artery. (A) Lateral esophagram shows a smooth, ovoid soft-tissue mass (M) lying between the distal trachea (T) and mid-esophagus (E) and causing marked esophageal narrowing. (B) Dynamic CT scan of the thorax shows that the mass is actually the proximal portion of a dilated left pulmonary artery (LPA), which has an anomalous origin from the right pulmonary artery and courses between the trachea (T) and the esophagus (E) toward the left hilum. (SVC, superior vena cava.)4

• Fig GI 3-5 Calcified mediastinal lymph nodes at the carinal level (arrow) cause a focal impression on and displacement of the esophagus.

• Fig GI 3-6 Squamous cell carcinoma of the lung produces a broad impression on the upper thoracic esophagus.

Fig GI 3-7 Squamous cell carcinoma of the lung impressing and invading the mid-thoracic esophagus.

• Fig GI 3-8 Thoracic osteophyte. Posterior extrinsic defect on the esophagus anterior to the T4 vertebral body. The osteophyte (*) was better shown on CT. Note the osteophytes and the flowing ossification anterior to the lower thoracic vertebral bodies (arrows) with preservation of the disk spaces.5

• Fig GI 3-9 Paraesophageal hernia impressing the distal esophagus.