Esophageal pathology represents a broad spectrum of conditions,
with a wide range from non-malignant to malignant entities.
It is important to recognize the radiological characteristics of each one,
although in most cases they can be overlapping.
Therefore,
we have recognized and adopted proposed ways to approach benign1 and malignant2 pathology separately,
resulting in a useful method that,
according to the findings by images,
provides a practical and reliable guide to the different diagnostic possibilities.
The principal objective of this article is to integrate knowledge of anatomy and imaging findings of the most common esophageal pathology in our environment and to summarize it in practical schemes of radiological evaluation of the esophagus that can that can facilitate our approach to esophageal pathology.
Anatomy of the esophagus:
The esophagus is a muscular tube that carries food and liquids from the pharynx to the stomach,
measures 23-37 cm long and has a diameter of 1 - 2 cm and consists of three parts: cervical,
thoracic and abdominal3,
Fig 1.
· Cervical esophagus (upper third) is the continuation of the hypopharynx and begins in the upper esophageal sphincter,
which is formed by the cricopharyngeal muscle,
located at the lower edge of the cricoid cartilage,
at the height of C5 or C6.
· Thoracic esophagus (middle third): starts from the upper thoracic operculum (T1) to the esophageal hiatus in the diaphragm (T10).
· Abdominal esophagus (lower third): The portion between the esophageal hiatus and the heart at the gastroesophageal junction.
The arterial supply,
the venous and lymphatic drainage of the esophagus depend on the esophageal segment in particular,
which have been summarized in Table 1.
It is important to recognize the natural physiologic points of normal esophageal constrictions,
as these are common places of foreign body impaction,
this should not be confused with pathological constrictions4,
it’s anatomical references are summarized in Table 2.
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The esophagus is covered by a stratified squamous epithelium and is made up of five layers,
own muscularis (external longitudinal and internal circular),
submucosal,
mucosal and mucosal muscularis.
It is important to remember that the esophagus does not present serosa because its absence allows a rapid tumor spread to structures neighboring the mediastinum.