Umer Salati MD, Presenter: Nothing to Disclose

Alison Hurley MBBCh, MRCS, Abstract Co-Author: Nothing to Disclose

Ken Courtney, Abstract Co-Author: Nothing to Disclose

William Carmelo Torreggiani MBBCh, Abstract Co-Author: Nothing to Disclose

Incidental apparent abnormalities of the distal oesophagus are commonly observed on cross sectioning imaging of the thorax. Many of these are referred for endoscopic correlation. The purpose of this study was to illustrate distal oesophageal thickness found incidentally on computed tomography (CT), and to correlate it with endoscopic findings.

A retrospective reviewof 2400 patients who underwent CT in a 3 month period was performed and those studies raising the possibility of distal esophageal mucosal abnormality were identified. Patients who had an endoscopy within 6 months of the CT were included in the final analysis. 379 patients met the inclusion criteria. Images were analysed on a dedicated workstation, independent of the endoscopy results, which were noted after the determination of abnormal thickness ( 9 mm) was made. Incidental findings such as hiatus hernias and varices were also noted. Data was analysed using Statistical Package for Social Sciences (SPSS) software. . The primary aim of the study was to identify patients with a thickened distal oesophagus or OGJ on CT and correlate this with endoscopy.

376 patients were included in the final analysis. Approximately 21% (n=79)of those patients were determined to have a thickened distal esophagus or OGJ on CT. Of these, 15.2% (n=12) had a mass or abnormal mucosal thickening on endoscopy which was found to be malignant (esophageal or gastric) on subsequent biopsy and histopathology in 83.3% (n=10) and Barrett’s epithelium in 16.7% (n=2). This was a statistically significant difference (p <0.001) when compared to the incidence of similar findings on endoscopy for those with a normal CT. Hiatus hernia accounted for nearly 38% of incidental findings on CT and was not an independent risk factor for malignancy. Although 54.4% of patients with esophageal thickening on CT had a hiatus hernia, it was only present on 7% (n=3) of cases with confirmed malignancy.

Increased distal oesophageal and OGJ thickness on CT is a statistically significant predictor of significant pathology on endoscopy. 15% of patients in this cohort had malignancy on endoscopy. Therefore, all patients felt to have increased oesophageal thickness on CT should be referred to endoscopy for further evaluation.  

Distal esophageal thickening found incidentally on CT should always be referred for endoscopy correlation.

Salati, U, Hurley, A, Courtney, K, Torreggiani, W, Incidental Distal Oesophageal Pathology on CT and its Correlation with Endoscopy: A Retrospective Study and Pictorial Review.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12025795.html