IS Case 404: Mid-esophageal radiation stricture
Imaging Sciences URMC 2010
Publication Date: 2010-08-27
History
Patient is a 74-year-old female with a history of non-small cell lung carcinoma (NSCLC) post-radiation presenting with dysphagia.
Findings
Findings consistent with mid-esophageal radiation stricture.
Diagnosis
Mid-esophageal radiation stricture
Discussion
Radiation stricture is a relatively common complication of mediastinal radiation therapy (XRT). Patients usually present with dysphagia but substernal pain and odynophagia can be present especially if there is a degree of radiation esophagitis. Symptoms of esophagitis typically begin two to three weeks after the onset of radiation therapy; a stricture can present anytime thereafter. Chronic motor dysfunction can be a problem even years after the therapy.
Radiation esophagitis is usually diagnosed clinically when given the history of XRT and the onset of symptoms. Persistence of symptoms can indicate a stricture. An upper GI examination is used to diagnose stricture or tracheoesophgeal (TE) fistula. Image findings include smooth tapered narrowing that may be granular in appearance with possible ulceration from adjacent lymphadenopathy or tumor. Adjacent lung fibrosis is an addition clue to diagnosing radiation induced stricture.
Differential diagnosis for radiation induced esophageal stricture includes stricture from reflux, caustic esophagitis, infection such as candida, chronic nasogastric intubation, or primary/metastatic tumor.
Esophageal stricture can be treated endoscopically with dilation and stent placement. PEG placement can also be used if oral nutrition is poor. The drug amifostine is sometimes used for its radio-protective benefit and can be given as a pretreatment for XRT.
References
- Collazzo LA, Levine MS, Rubesin SE, Laufer I. Acute radiation esophagitis: radiographic findings. AJR Am J Roentgenol. 1997 Oct;169(4):1067-70. PMID: 9308466
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