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Case 20 

Case 20
Chapter:
Case 20
Author(s):

Ellen Chung

DOI:
10.1093/med/9780199758968.003.0020
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date: 23 March 2019

6-year-old boy with dysphagia.

Single-phase esophagram demonstrates a long tapered narrowing of the mid-esophagus (arrowheads).

The differential diagnosis of a mid-esophageal narrowing also includes congenital causes (extrinsic compression from vascular ring or esophageal duplication cyst, intrinsic congenital esophageal stenosis), post-traumatic causes (caustic or disk battery ingestion, stricture after esophageal atresia repair), and infectious/inflammatory causes (candidiasis, cytomegalovirus, Barrett esophagus, Behçet disease, Crohn disease, epidermolysis bullosa, radiation therapy, and graft-versus-host disease). All of these appear similar radiographically, but clinical and laboratory data help to narrow the differential. Some radiographic findings are suggestive of certain diagnoses. Vascular rings cause smooth esophageal impressions at specific locations. Congenital esophageal stenosis may be associated with a ringed appearance, as can eosinophilic esophagitis. Infectious etiologies often cause marked mucosal irregularities. Peptic strictures most commonly involve the distal esophagus....

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