Gastrointestinal Imaging

Oesophagitis, infectious, mycobacterial

The oesophagus may be affected in tuberculosis by three different mechanisms. The most frequent involvement concerns the middle third of the oesophagus at the level of the tracheobronchial bifurcation and is characterized by localized ulcerative lesions and fistula formation. These lesions are caused by local extension of involved mediastinal lymph nodes. Secondly, tuberculous pharyngitis or laryngitis may spread directly to the contiguous or adjacent proximal portion of the oesophagus. Rarely multiple mucosal granulomas that may involve every portion of the oesophagus may be caused by haematogeneous dissemination of the infection.

In the first form, barium study will reveal large, deeply penetrating ulcers and fistulous tracts between the middle third of the oesophagus and the mediastinum as well as the bronchi will be well demonstrated on the barium study and on CT. Moreover, the fibrosing reaction in the perioesophageal mediastinal tissue will frequently result in stricture formation. In the two other forms, findings on barium study are subtle or nonvisible. Also, see tuberculosis gastrointestinal.

ALB