食管中医药学课程.pptVIP

Esophagus I : Anatomy, Function, Hiatus hernia, Esophagitis Terrence C. Demos, MD, Harold V. Posniak, MD, Wayde Nagamine, MD and Mary Olson, MD Department of Radiology of the Loyola University Medical Center, USA Anatomy and Function Lower esophageal rings Webs and Diverticula Hiatus hernia Inflammation and Infection Lower esophageal rings Esophageal ring due to muscular contraction. It varies during examination and may not persist. A-Ring Muscular contraction at the junction of tubular and vestibular esophagus No definite anatomic correlate B-Ring Mucosal ring at anatomic squamocolumnar junction (Z-line) Best or only seen with vestibular distension Normally 1 cm above diaphragm May cause episodic dysphagia if esophagus is narrowed, then termed a Schatzki ring (食管下部蹼 ) 20 mm wide, no obstruction 13 mm wide, almost always intermittent obstruction 13-20 mm wide, may obstruct On the left a patient with a ring due to muscular contraction. Notice incidental gastric diverticulum (asterisk). Esophageal A-ring due to muscular contraction. It varies during examination and may not persist.On the left another patient with a non-persistent ring at the apex of a sliding hiatus hernia. The esophageal B-ring is located at the squamocolumnar junction, also termed the Z line. The appearance does not change during the examination. On the left a patient with a B ring (arrows) several cm above diaphragm at the apex of sliding hiatus hernia.Note unchanged appearance on these two images. On the left a 52-year-old man with episodic dysphagia.The image on the far left does not show a abnormality, but distal esophagus not distended .With dilation of the distal esophagus, a 13 mm wide Schatzki B-ring (arrows) that caused intermittent obstruction is demonstrated at the apex of a hiatus hernia (arrowhead). On the left a 71-year-old man with chest pain after fast food lunch.Distal obstructing filling defect (arrow) is a piece of meat that passed into stomach during stu