Esophageal lipomatosis: another consequence of the use of steroids

After we incidentally found on CT extensive esophageal fat accumulations in a patient with long-term use of steroids, we prospectively evaluated durin g a 6-month period all CT studies of the chest esophageal lipomatosis and r elated the findings to the possible use of steroids. The diagnosis of esoph ageal fat on CT was made by density measurements or if too small for reliab le density measurements by comparison with mediastinal fat. In 21 of 1320 e xclusively older male patients the diagnosis of esophageal lipomatosis was definite in 7 and likely in 14 patients. All fat accumulations were located in the upper third of the esophagus (mean length 22 +/- 6 mm) and presente d ring-like (n = 10), irregular (n = 3), or as a horseshoe sparing the post erior border (n = 8). Tn 20 patients there was an unequivocal history of st eroid treatment. Associated centripetal fat infiltration was found in 11 pa tients. None of the patients had swallowing problems. Prolonged use of ster oids, either orally or inhalationally administered, is associated with esop hageal lipomatosis. The predisposition for the upper esophagus might be rel ated to the presence of striated muscle cells in this part of the esophagus ; moreover, inhalational steroid thera-may adversely affect the upper esoph agus.