Learning Radiology xray montage

Esophageal Candidiasis
Monilial Esophagitis

  • Most common cause of infectious esophagitis
  • Organism
    • C. albicans
    • Found in diseased skin, GI tract, female genital tract, urine in patients with an with an indwelling Foley catheter
  • Usually occurs as an opportunistic infection in those with
    • Depressed immunity
      • AIDS
      • Hematologic disease
      • Renal transplant
      • Leukemia
      • Chronic debilitating disease
    • Diabetes mellitus
    • Steroids
    • Chemotherapy
    • Radiotherapy
    • Diseases which cause delayed esophageal emptying
      • Scleroderma
      • Strictures
      • Achalasia
      • S/P fundoplication
    • Rarely may occur in otherwise healthy individuals
  • Produces whitish slightly raised plaques

  • Clinical Findings

    • Dysphagia
    • Odynophagia
    • Intense substernal pain
    • Associated with oral thrush (oropharyngeal moniliasis) in 20-80%

  • Location

    • Predilection for upper 1/2 of esophagus
      • Involvement of long esophageal segments

  • Imaging Findings

    • Discrete plaque-like lesions
    • Plaques line-up longitudinally = grouping of tiny 1-2 mm nodular filling defects with linear orientation
    • Larger plaques may coalesce to produce "cobblestone" appearance
    • Further coalescence produces “shaggy” contour (from coalescent plaques, pseudomembranes, erosions, ulcerations, intramural hemorrhage) in fulminant candidiasis
      • More fulminant form is more often associated with AIDS

candida esophagitis

Candida Esophagitis (Moniliasis). Double-contrast esophagram shows markedly nodular mucosa
with multiple discrete ulcers covering all of esophagus

  • Ulcers invariably appear only on a background of diffuse plaque formation, not as isolated findings
  • Long, smoothly-tapering strictures may develop but are rare
    • More likely to develop in patients with cutaneous manifestations of Candidiasis
  • Mycetoma resembling large intraluminal tumor is rare
  • Diagnosis

    • Endoscopy most sensitive method of making diagnosis for mild cases
    • Double-contrast esophagography should pick up 90% of cases

  • Treatment

    • Mycostatin®
    • Findings usually regress quickly

  • Differential Diagnosis

    • Glycogenic esophagitis – asymptomatic nodularity
    • Reflux esophagitis – distal esophagus, nodules poorly defined
    • Superficial spreading carcinoma- nodular and irregular folds
    • Artifacts (undissolved effervescent crystals, air bubbles, retained food particles)
    • Herpes esophagitis – discrete ulcers surrounded by halo of edema
    • Acute caustic ingestion – long strictures are common
    • Intramural pseudodiverticulosis – unlike ulcers, pseudodiverticula don’t appear to connect to lumen
    • Varices – distal esophagus usually; serpiginous elongated filling defects


Candidiasis. Multiple images from a barium esophagram show slight irregularity of the wall (red arrows) caused by shallow ulcerations and deeper, barium-containing ulcers as well (white oval).