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The small-caliber esophagus: radiographic sign of idiopathic eosinophilic esophagitis. Radiology 2010 Jul;256(1):127-34

Date

05/28/2010

Pubmed ID

20505062

DOI

10.1148/radiol.10091060

Scopus ID

2-s2.0-77953947962   39 Citations

Abstract

PURPOSE: To evaluate a small-caliber esophagus at barium esophagography with idiopathic eosinophilic esophagitis (IEE) and determine if there is a useful threshold diameter for suggesting this diagnosis.

MATERIALS AND METHODS: The institutional review board approved this retrospective study and waived informed consent. This study was HIPAA compliant. A search of the radiology database (by using the search term small-caliber esophagus) revealed 10 patients with a small-caliber esophagus at barium esophagography who had IEE (defined as more than 20 eosinophils per high-power field in endoscopic biopsy specimens). Images were reviewed to characterize findings and determine the length of narrowing. Luminal diameters were measured at three levels for nine patients and nine control subjects, and mean diameter, range, and standard deviation were determined at each level. An analysis of variance test was performed to determine whether the difference between the range of mean thoracic esophageal diameters in patients with IEE versus that in control subjects was significant.

RESULTS: All 10 patients had long-segment but variable-length narrowing of the thoracic esophagus (mean length, 15.4 cm) with tapered margins. The mean diameter at the aortic arch, carina, and one vertebral body above the gastroesophageal junction was 13.9, 14.3, and 15.1 mm, respectively, for patients with small-caliber esophagus versus 20.2, 30.3, and 28.7 mm for control subjects. The mean overall diameter was 14.7 mm for patients with small-caliber esophagus versus 26.3 mm for control subjects. In the nine patients in whom the luminal diameter was measured, the mean thoracic esophageal diameter was 20 mm or less; all nine control subjects had a mean thoracic esophageal diameter greater than 20 mm. The difference in the range of mean thoracic esophageal diameters between these two groups was highly significant (P < .0001), so 20 mm was a useful threshold diameter for suggesting this diagnosis.

CONCLUSION: The small-caliber esophagus of IEE is characterized at barium esophagography by long-segment but variable-length narrowing of the thoracic esophagus, with a mean length of 15.4 cm, a diameter of 20 mm or less, smooth contours, and tapered margins.

Author List

White SB, Levine MS, Rubesin SE, Spencer GS, Katzka DA, Laufer I

Author

Sarah B. White MD, MS, FSIR, FCIRSE Vice Chair, Professor in the Radiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Analysis of Variance
Barium Sulfate
Contrast Media
Eosinophilia
Esophageal Stenosis
Esophagitis
Esophagoscopy
Female
Humans
Male
Middle Aged
Radiographic Image Interpretation, Computer-Assisted
Retrospective Studies