대한흉부영상의학회 Weekly Chest Cases

Case No : 1435 Date 2025-04-21

Courtesy of Min Hyuk Yu, Ho Yun Lee / Samsung Medical Center
Age/Sex 71 / M
Chief ComplaintDysphagia, recurrent vomiting for one month; Within normal range in EGD (1 month ago)

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Diagnosis With Brief Discussion

Diagnosis: Eosinophilic esophagitis
Radiologic Findings: Fig 1. Chest radiograph shows bulging esophageal shadow in the left paraspinal area.
Fig 2, 3 Axial contrast-enhanced CT images demonstrate diffuse circumferential, edematous wall thickening of the esophagus with periesophageal fluid collection. No periesophageal infiltration is noted.
Fig 4. Coronal non-enhanced CT image shows diffuse wall thickening involving the entire length of the esophagus.
Brief Review: The patient underwent repeat EGD and esophageal biopsy after the CT. Pathologic examination revealed esophagitis with marked eosinophilic infiltration, consistent with eosinophilic esophagitis.
Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated esophageal disease that primarily affects young males, with a male-to-female ratio of 3:1. The condition is characterized by symptoms of esophageal dysfunction, particularly dysphagia and recurrent food impactions, and histologically by eosinophil-predominant inflammation (>20 eosinophils per high-power field on endoscopic biopsy).
Radiologic findings of EoE can be observed on various imaging modalities. On chest radiographs, the esophageal shadow may appear prominent with bulging contour. CT typically demonstrates diffuse circumferential wall thickening of the esophagus, sometimes accompanied by periesophageal fluid collection, as seen in this case. On barium esophagography, characteristic findings include multiple rings in the mid- or distal esophagus (ringed esophagus), which are highly specific for EoE. Long-segment strictures may also be present, often associated with mild mucosal irregularity but without ulcerations.
While many patients have concurrent allergic conditions such as asthma, eczema, or food allergies, EoE can occur as an isolated condition in adults without other allergic manifestations. Treatment options include oral corticosteroids, leukotriene inhibitors, and newer biologics such as anti-interleukin monoclonal antibodies and eotaxin inhibitors. For patients with strictures, esophageal dilatation may be considered for symptomatic relief.
References: 1. Zimmerman SL, Levine MS, Rubesin SE, et al. Idiopathic eosinophilic esophagitis in adults: the ringed esophagus. Radiology. 2005;236(1):159-165.
2. Alampady S. Comprehensive Update on Select Immune-Mediated Gastroenterocolitis Syndromes: Implications for Diagnosis and management. RadioGraphics 2010;30:1465-1487
3. Stefan L. Idiopathic Eosinophilic Esophagitis in Adults: The Ringed Esophagus. Radiology 2005; 236:159-165
Keywords

No. of Applicants : 62

▶ Correct Answer : 16/62, 25.8%

- , Sweden MOHAMAD TLASS
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Kyoto University , Japan SHO KOYASU
- Teikyo University Hospital , Japan CHIAKI SATO
- Kyoto University , Japan AKIHIKO SAKATA
- , Italy PAOLO BALDASSARI
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- University of Yamanashi , Japan TAKAAKI HASHIMOTO
- Samsung Medical Center , Korea (South) SEONGUK KIM
- Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
- , Japan JOJI KURASHIMA
- Ajou University Hospital , Korea (South) YOU NA KIM
- Toyota Kosei Hospital , Japan YUKI HAYASHI
- , Japan YOSHIKI ISHII
- ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
- , Japan YUMI MAEHARA

▶ Correct Answer as Differential Diagnosis : 11/62, 17.7%

- Fukuoka university , Japan KEISUKE SATO
- University of Yamanashi , Japan KOJIRO ONOHARA
- Shiga University of Medical Science , Japan AKITOSHI INOUE
- TB centre kasaragod. , India rikhy krishnan
- McGill University Health Center , Canada ALEXANDRE SEMIONOV
- Dokkyo Medical University , Japan HIROAKI ARAKAWA
- , Japan SUZUNE TSUKAMOTO
- GHICL , France MANUEL TOLEDANO
- Kantou Rousai Hospital , Japan KAORU SUMIDA
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1435 Date 2025-04-21

Discussion

No. of Applicants : 62