Intramurale Pseudodivertikulose des Ösophagus
Esophageal intramural pseudodiverticulosis is an uncommon condition in which there are numerous small outpouchings within the esophageal wall.
Epidemiology
It is a rare condition, found in <1% of oesophagrams. It may occur at any age, but is more common between 50 and 70 years. There is a slight male predominance .
Associations
- esophageal strictures: present in 90% of patients
- gastroesophageal reflux
- esophageal candidiasis
- chronic esophagitis
- esophageal carcinoma
Pathology
Intramural pseudodiverticula represent dilated excretory ducts of the deep esophageal mucosal glands .
Radiographic features
Fluoroscopy
Barium swallow examination is the study of choice, as the ductal orifices may be too small to be seen on endoscopy. Pseudodiverticula are better seen with a single contrast examination than with a double contrast, thin barium examination .
- numerous, tiny (1-4 mm), flask-shaped outpouchings
- may be diffusely distributed or clustered
- clustering may occur next to peptic strictures
- viewed in profile, often appear “floating” next to the esophageal wall, as the channel to the lumen is imperceptible
- viewed en face, may appear as ulcers
- intramural tracking may sometimes be seen bridging two or more pseudodiverticula
Treatment and prognosis
The treatment of esophageal pseudodiverticulosis is dependent on symptoms displayed and accompanying conditions . Around 10% of patients do no require treatment . The use of proton pump inhibitors can help relieve symptoms of esophagitis. If esophageal strictures are present, the use of endoscopic dilatation helps improve treatment response .
Pseudodiverticular rupture with resultant mediastinitis has been reported but is very rare .
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Assoziationen und Differentialdiagnosen zu Intramurale Pseudodivertikulose des Ösophagus:
