主訴:慢性吞嚥困難
dilated esophagus, with postive “bird beak sign”
Esophageal dilatation, 想到achalasia, scleroderma, esophageal carcinoma, esophagitis with stricture and post-OP change.
- Achalasia: 末端平滑肌無法放鬆,是myenteric plexus 疾病,典型影像特徵為”bird beak sign”
- Scleroderma: 結締組織疾病,特徵為平滑肌出現纖維化。在食道,影響後2/3部分(因為後2/3有平滑肌)特徵為"patolous dilation of the GE junction”,可用來和achalasia 作區別。Radiopaedia 有一個病例影片可看(https://radiopaedia.org/cases/systemic-sclerosis-1?lang=us)
- Esophageal carcinoma:mass effect,描述的方式為shouldering mass effect
- Esophagitis and stricture: 長期逆流造成,通常伴隨有hiatal hernia。影像上可以看到正常的peristalsis。
- Post-OP: 查病史
Ans: achalasia