ACUTE RADIATION ESOPHAGITIS - RADIOGRAPHIC FINDINGS

OBJECTIVE. The purpose of this study was to assess the findings of acu te radiation esophagitis in patients who undergo double-and single-con trast esophagograms and, specifically, to evaluate the presence or abs ence of a granular mucosa in these patients. MATERIALS AND METHODS. We retrospectively reviewed the radiographic findings in 13 patients wit h acute radiation esophagitis who underwent double-contrast (n = 8) or single-contrast (n = 5) esophagograms at our hospital between 1988 an d 1996. The barium studies were obtained 13-87 days (average, 39 days) after the initiation of radiation therapy because of acute odynophagi a, dysphagia, or both. RESULTS. Of the 13 patients with acute radiatio n esophagitis, the upper thoracic esophagus was involved in three pati ents, the mid esophagus in four, the distal esophagus in four, and the mid and distal esophagus in two. Of the eight patients who underwent double-contrast esophagograms, three (37%) had multiple small, discret e ulcers; four (50%) had a distinctive granular appearance of the muco sa; and one (13%) had both. In all eight patients, this ulceration or granularity was associated with variable esophageal narrowing within a known radiation portal. Of the five patients who underwent single-con trast esophagograms, two had esophageal narrowing, one had narrowing a nd ulceration, and two had thickened folds. Of the four patients who a lso underwent follow-up barium studies, three developed radiation stri ctures at the site of the previous injury. CONCLUSION. In patients wit h acute radiation esophagitis, double-contrast esophagograms may revea l a variable segment of esophageal narrowing with multiple discrete ul cers or a distinctive granular appearance of the mucosa within a known radiation portal. In the appropriate clinical setting, the diagnosis should be suggested by this constellation of findings.