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Weekly Chest CasesArchive of Old Cases

Case No : 976 Date 2016-07-11

  • Courtesy of Min Ji Jang, Soyeoun Lim, Un Jung Kwon / Ulsan University Hospital, Korea
  • Age/Sex 68 / M
  • Chief ComplaintDysphagia for one month
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Eosinophilic Esophagitis
Radiologic Findings
Axial enhanced CT scans show diffuse circumferential, homogeneous, low attenuation wall thickening of the entire length of the esophagus. Poorly enhancing mucosa appears intact. There is no significant periesophageal fat infiltration.
Coronal reformatted image shows the diffuse concentric wall thickening involving the entire esophagus.
Endoscopic image shows sessile white papules and relatively decreased vascularity of the whole esophagus.
Biopsy showed squamous cell epithelium with many eosinophils, consistent with eosinophilic esophagitis.
Brief Review
Eosinophilic esophagitis is defined as a chronic immune/antigen-mediated esophageal disease characterized clinically by symptoms of esophageal
dysfunction and histologically by eosinophil-predominant inflammation. The majority of patients are diagnosed in the second through fifth decade. There is a male predominance, with a male/female ratio of 3:1. Patients may have concurrent allergic diatheses, including asthma, eczema, rhinitis, atopic dermatitis, or seasonal or food allergies.
Eosinophilic esophagitis presents with endoscopically identified esophageal
abnormalities, including longitudinal furrow, white exudates, rings, strictures, edema, and a narrow-caliber esophageal lumen.
On barium esophagograms, multiple rings in the mid- or distal esophagus are highly specific for eosinophilic esophagitis. Long-segment strictures in the mid or distal esophagus also may be seen, without ulcerations, in association with mild mucosal irregularity.
On CT, diffuse mural thickening of the esophagus may be seen.
In adults, available therapeutic options include oral corticosteroids and leukotriene inhibitors as well as newer anti-interleukin monoclonal antibodies and eotaxin inhibitors. Esophageal dilatation may be performed for symptomatic
patients with strictures.
References
1. Alampady S. Comprehensive Update on Select Immune-Mediated Gastroenterocolitis Syndromes: Implications for Diagnosis and management. RadioGraphics 2010;30:1465-1487
2. Stefan L. Idiopathic Eosinophilic Esophagitis in Adults: The Ringed Esophagus. Radiology 2005; 236:159-165
Keywords
Esophagus, Non-infectious inflammation,

No. of Applicants : 74

▶ Correct Answer : 16/74,  21.6%
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Military service , Korea (South) Dongryul Jang
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Kizawa Memorial Hospital , Japan Tomohiro Ando
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - Narayana Multispeciality Hospital Jaipur Raj , India JAINENDRA JAIN
  • - GHICL , France manuel toledano
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - Asan medical center , Korea (South) Cherry Kim
  • - Seoul National University Bundang Hospital , Korea (South) Jee Hye Hur
  • - Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
  • - Centre Imagerie de Fribourg , Switzerland Benoit RIZK
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan Tomoaki Otani
  • - Niigata University , Japan Atsushi Uehara
▶ Correct Answer as Differential Diagnosis : 4/74,  5.4%
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia Yuranga Weerakkody
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Nasaret Hospital , Korea (South) Hee Seok Choi
▶ Semi-Correct Answer : 21/74,  28.4%
  • - Aerospace medical group, Air Force Education and Training Command , Korea (South) Donghwan Kim
  • - Kyungpook national university hospital, Korea , Korea (South) Sung Jun Moon
  • - MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
  • - Saitama-Sekishinkai Hosptal , Japan Mihoko Yamazaki
  • - radiologist, aditya imaging centre , India vivek patel
  • - ROKAF 10th Fighter Wing , Korea (South) Kun Woo Kang
  • - , Korea (South)
  • - , Korea (South) BAEK YOOLIM
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Pamukkale University, Faculty of Medicine, Dept. of Radiology , Turkey Furkan Ufuk
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - the first affiliatited hospital of nanjing medical univercity , China Hai Xu
  • - The Jikei university , Japan Taku Gomi
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - Department of Radiology, Seoul National University Bundang Hospital , Korea (South) Sung Hyun Yoon
  • - Kanto Rosai Hospital , Japan Taku Tajima
  • - Seoul national university hospital , Korea (South) Kumju Chae
  • - University of Tsukuba , Japan Toshitaka Ishiguro
  • - okayama university , Japan numa shingo
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
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