Comparative imaging studies of congenital pyriform sinus fistula using barium esophagography and CT / 实用放射学杂志

Objective To evaluate the value of barium esophagography and CT in the diagnosis of congenital pyriform sinus fistula (CPSF).Methods The preoperative radiographic data of 5 9 CPSF patients were analyzed retrospectively,which were confirmed by operation.5 5 patients underwent barium esophagography,and 5 7 patients underwent pre-and post-contrast CT scans.The images of barium esophagography and CT were analyzed and the positive diagnostic rates (PDR)between the two imaging modalities and among the different CT features were compared.Results Among the 5 9 patients,left fistula was found in 5 5 cases,right fistula was found in 2 cases and bilateral fistula in 2 cases.For the patients examined with barium esophagography,53 sinus tracts or fistulas from the pyriform in 52 patients(including 2 patients with bilateral fistula)were depicted.The other 3 patients had negative results.The overall PDR of barium esophagography was 93.0%(53/57).CT findings of CPSF included the narrowness of pyriform fossa,sinus tract or fistula in the neck,bubble sign medial to the superior pole of thyroid,low density in thyroid,thyroid morphologic change,and so on.For the 5 7 patients (including 2 patients with bilateral fistula)examined with CT.The PDR of narrowness of pyriform fossa was 44.1%(26/59),the PDR of sinus tract or fistula was 1 3.6%(8/5 9),the PDR of bubble sign medial to the superior pole of thyroid was 55.9%(33/5 9),the PDR of low density in thyroid was 1 6.9%(1 0/5 9),the PDR of thyroid morphologic change(defect sign of superior pole of thyroid)was 9 1.5%(54/5 9 ).And the total PDR of thyroid density or morphologic change was 94.9%(56/59).Conclusion Barium esophagography can be the main modality to diagnose CPSF because of its high PDR.Although the PDR of CT for direct sign(sinus tract or fistula)is not high,its PDR for indirect sign (thyroid density or morphologic change)is very high.So CT has great value for patients suspected of CPSF.

Progress in diagnosis and treatment of pyriform fistula in children / 国际儿科学杂志

Pyriform sinus fistula,owing to rare disease incidence and lacking of awareness,is always a puzzle to neck illness. At the mean time,The frequent delay in accurate diagnosis was reported in the literature. Pyriform sinus fistula should be considered in any children with repeated neck or thyroid infection/mass( mainly on the left side) . The combination of barium esophagography,CT scan and ultrasound is useful to establish the diagnosis. Intraoperative endoscopy-assisted intubation or methylene blue injection through the internal opening as a guide can facilitate identification of the tract during dissection,and it can effectively reduce the relapse rate.

Correlation between Clinical Symptoms and Radiologic Findings before and after Pneumatic Balloon Dilatation for Achalasia / 대한소화기학회지

BACKGROUND/AIMS: We investigated the risk factors for short-term recurrence and analyzed the correlation between subjective clinical symtoms and objective radiological findings in patients with achalasia undergoing pneumatic balloon dilatation. METHODS: Twenty patients who were treated by pneumatic balloon dilatation were enrolled. We compared prospectively various indices before and after the treatment as follows: 1) Eckardt symptom score and dysphagia grade, 2) The ratio of the maximal width in mid-esophageal lumen to the minimal width in distal esophagus around lower esophageal sphincter, and 3) the percentage of maximum activity retained in the esophagus at 30 seconds and T in esophageal scan two days after the treatment. RESULTS: 1) Clinical indices and radiologic indices significantly improved after pneumatic dilatation. 2) There was no significant correlation between the clinical indices and the radiologic indices before and after the treatment. 3) The difference percentage of clinical indices did not show significant correlation with the difference percentage of the radiologic indices. 4) Compared to the group above 20% in the difference percentage of 30 second residual fraction, the one below 20% had a four-fold risk in short-term recurrence. CONCLUSIONS: Clinical symptoms and radiologic indices significantly improve after pneumatic dilatation but have no significant correlation to each other. The group below 20% in the difference percentage of 30 second residual fraction has a high risk of recurrence and may need careful examination and early repeated pneumatic dilation.

A Case of H-type Tracheoesophageal Fistula Diagnosed by Esophagography in Prone Position

An H-type tracheoesophageal fistula is a rare congenital condition of which incidence is approximately 1: 50, 000-80, 000 births. Although patient usually has recurrent respiratory symptoms such as choking episodes and cyanotic spells, its rarity and atypical symptoms may delay its detection. Besides, conventional esophagogram often fail to find the defect. We reported a case of H-type tracheoesophageal fistula, diagnosed by tube esophagram with infant in the prone position. During the test, contrast medium was injected while the catheter is slowly withdraws from lower esophagus.

Imaging Findings of Giant Liposarcoma of the Esophagus

A giant esophageal liposarcoma showing rapid growth over 7 months is presented in 56-year-old man. It originated from the pharyngo-esophageal junction with a short stalk, and extended downward to the distal esophagus. A barium swallow study showed a large, sausage-like intraluminal mass in the dilated esophagus. CT and MR imaging showed a heterogeneous mass with a fatty component in the esophagus. A total laryngopharyngo-esophagectomy was performed and the histological diagnosis was of a well-differentiated liposarcoma.

A case of achalasia without dilatation of the esophageal body / 대한소화관운동학회지

Achalasia is a motility disorder of the esophagus consisting of abnormal relaxation of the lower esophageal sphincter and aperistalsis of the esophageal body. Esophageal dilatation and bird beak appearance are characteristic radiologic findings of achalasia, but achalasia patients do not always show typical findings on esophagography. We recently experienced a 38-year-old female patient who complained of chest pain and dysphagia. She showed no dilatation of the esophagus with delayed emptying of the contrast media in esophagography, but achalasia was diagnosed by typical manometric findings. The patient's symptoms improved after a balloon dilatation. Therefore, esophageal manometry should always be performed when the patient's history suggests the presence of achalasia without typical radiologic findings. We report this case with a review of the literature.