Esophageal Web

 

• Ringlike constriction of upper esophagus covered on superior and inferior surfaces by squamous epithelium
• Three types have been described:
  • A non-specific or idiopathic web (most common)
  • Webs associated with Plummer-Vinson Syndrome
  • Webs associated with epidermolysis bullosa dystrophica or graft-versus-host disease
• Usually found in middle-aged females
• Plummer-Vinson Syndrome=Patterson-Kelly syndrome
  • Iron deficiency anemia
  • Stomatitis
  • Glossitis
  • Dysphagia
  • Spoon-shaped nails
  • Esophageal webs
  • Some question as to whether such a syndrome exists
• Location
  • Cervical esophagus anteriorly at level of the cricopharyngeous (C5-C6)
  • Best visualized with maximal distension
  • Distal esophageal webs may arise from gastroesophageal reflux
• Imaging Findings
  • Thin, transverse filling defects
  • Perpendicular to anterior esophageal wall
  • Usually less than 3mm in thickness
  • Frequently they are not circumferential

Barium esophagram demonstrates a thin membrane arising from the anterior wall of the cervical
esophagus at the level of C5-C6 without circumferential involvement of the lumen characteristic
for an esophageal web
For a larger image, double click the photo itself

• Increased risk of upper esophageal carcinoma
• DDx
  • Prominent cricopharyngeous muscle
    • Arises posteriorly at C5-C6 and produces a much broader defect
  • Stricture
• Treatment
  • Balloon dilatation
  • Bougienage during esophagoscopy

 

Halpert, R and Feczko, P: Requisites of Gastrointestinal Radiology, 2^nd edition, 1999.