Corrosive injuries of the upper gastrointestinal tract: A pictorial review of the imaging features

Abstract

Corrosive ingestion is a common form of poisoning. Corrosive agents cause severe damage to the gastrointestinal (GI) tract. The most severe forms of injury can lead to mortality; however, the major concern with this type of injury is life-long morbidity. Upper GI endoscopy is the test of choice for assessing severity in the acute phase of the disease. The long-term management is based on the site, length, number, location, and tightness of the stricture. This information is best provided by the barium contrast studies. In this pictorial review, a spectrum of findings in patients with corrosive injuries of the esophagus and stomach is illustrated. The role of various imaging modalities including barium studies, endoscopic ultrasound, computed tomography, and magnetic resonance imaging is discussed.

Keywords: Barium; corrosive; stricture.

Figure 1

Typical esophageal corrosive stricture: there is a smooth symmetrical mid-esophageal stricture (arrow)

Figure 2

Short-segment stricture: there is a short segment stricture involving the cervical esophagus (arrow)

Figure 3 (A and B)

Long-segment stricture: two different patients with long-segment involvement. (A) shows the involvement of thoracic esophagus and (B) shows the involvement of cervical esophagus

Figure 4

Multiple strictures: there are multiple strictures involving the cervical and upper thoracic esophagus (arrows)

Figure 5

Web-like stenosis: there is a web-like narrowing of the cervical esophagus (arrow)

Figure 6

Stricture mimicking achalasia: there is a short-segment stricture involving the gastroesophageal junction (arrow) with marked dilatation of the proximal esophagus resembling achalasia

Figure 7

Stenosis of antropyloric region: there is stenosis involving antropyloric region (arrow)

Figure 8

Involvement of the body of stomach: there is a narrowing of the body of the stomach (arrow). Also, note the involvement of the duodenum with multiple pseudodiverticula (short arrows)

Figure 9

Gastric contraction: there is a marked reduction in the entire gastric volume (arrows) with linitis-plastica-like appearance

Figure 10

Stricture of the antropyloric region and duodenum: there is a long-segment narrowing of the antropyloric region and the first part of the duodenum (arrow)

Figure 11

Intramural esophageal diverticula: there is a long-segment narrowing of the mid-thoracic esophagus with intramural diverticula along the entire length (arrow)

Figure 12

Sacculation: there are multiple sacculations along the mid-thoracic esophagus (arrows)

Figure 13

Intramural contrast leak: there is a long contrast filled tract extending along the posterior aspect of the cervical and upper thoracic esophagus

Figure 14

Corrosive ingestion associated esophageal cancer: there is an asymmetrical stricture with ulceration involving the lower thoracic esophagus (arrow)

Figure 15

Corrosive injury of the esophagus: computed tomography (CT): axial and coronal reformatted CT images show smooth circumferential wall thickening of the mid and distal esophagus (arrows)

Figure 16

Corrosive injury of the stomach: computed tomography (CT): axial and coronal reformatted CT images show diffuse circumferential wall thickening of the stomach with marked volume loss

Figure 17

Corrosive injury of the esophagus: endoscopic ultrasound (EUS):radial EUS image shows asymmetric mural thickening of the esophagus. Note significantly thickened and hypoechoic muscularis propria (cursors and arrow)

Figure 18

Corrosive injury of the esophagus: magnetic resonance imaging: axial T2-weighted images show mild narrowing in the mid-thoracic esophagus (left arrow) with upstream dilatation (right arrow)