A case of oesophageal carcinoma: 3D CT imaging findings

Clinical History

A patient presenting with the recent onset of progressive dysphagia underwent a multislice spiral CT examination.

Imaging Findings

The patient presented with progressive dysphagia of recent onset. A double contrast oesophagogram was performed, which showed a tight stenosis in the medial portion of the oesophagus, which extending for 7cm. Subsequent endoscopy revealed a tender oesophageal mass, which occluded more than 50% of the oesophageal lumen. A follow-up total body CT scan staged the lesion as T3. Virtual endoscopy was also performed and the images correlated with the corresponding features obtained with traditional endoscopy.

Discussion

The most common tumour of the oesophagus remains the squamous cell carcinoma, accounting for approximately 7% of gastrointestinal tract cancers and 1% of all cancers, although the incidence is decreasing. Affected patients are usually males, in the age range 50-70 years. The aetiology is multifactorial, but clearly involves the combination of alcohol and tobacco. A strong association with squamous cell carcinoma of the head and neck is reported. Other predisposing conditions include lung cancers, lye stricture achalasia, coeliac disease, Plummer Vinson syndrome, and tylosis palmaris. The lesions are most commonly seen within the thoracic oesophagus, especially its mid portion, as in this case.

The oesophagus is hollow and may appear collapsed on routine CT. Its non-distended wall may appear thickened, nodular and irregular, thus simulating a tumour, even if normal. Furthermore it is difficult to judge the superior and inferior extent of oesophageal tumours on standard CT examination. When the oesophagus is adequately distended prior to examination, 3D image reconstruction of the oesophageal lumen is possible. In the evaluation of oesophageal diseases, the use of an anti-peristaltic drug suppresses normal peristalsis, which may simulate tumour thickening of the oesophageal wall.

As shown by this case, multislice spiral CT may provide highly accurate identification and staging of oesophageal carcinoma. In addition, virtual endoscopy may allow internal visualisation of the mass, which is roughly comparable to traditional endoscopic images.

Differential Diagnosis List

Final Diagnosis

Carinoma of the oesophagus

URL:	https://www.eurorad.org/case/2076
DOI:	10.1594/EURORAD/CASE.2076
ISSN:	1563-4086