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Esophagus Quiz Answers

1.  The most common form of tracheal-esophageal fistual is: A. esophageal atresia with a proximal TEF B. esophageal atresia with a double TEF C. an isolated esophageal atresia D. esophageal atresia with a distal TE E. an isolated TEF D: Esophageal atresia with a distal TEF is by far the most common (87%) form of TEF, followed by isolated esophageal atresia (8%), isolated TEF (4%), esophageal atresia with proximal TEF (1%), and esophageal atresia with double TEF (1%).

2.  Communicating esophageal duplications are four times more common than noncommunicating esophageal duplications. True False FALSE: Noncommunicating esophageal duplications are four times more common than communicating duplications.

3.  It is radiographically impossible to differentiate esophogeal duplications from bronchiogenic cysts. True False TRUE: Radiographically, it is not possible to differentiate esophageal duplications from bronchiogenic cysts.

4.  All lower esophageal rings are classified as Schatzki rings. True False FALSE: Only those esophageal rings that cause dysphagia or that are symptomatic, as there are many that are asymptomatic, are classified as Schatzki rings.

5.  The following images depict: A. Infectious esophagitis B. Scleroderma C. Esophageal varices C: Image A is an esophagram showing the serpiginous filling defects due to varices, and image B shows "uphill" varices due to portal hypertension.

6.  Which of the following may be associated with thoracic esophageal rupture: A. hydropneumothorax B. widened mediastinum C. pneumomediastinum D. pleural effusion E. All of the above E: On plain films, a widened mediastinum and pneumomediastinum may be present. Also, approximately 75% of thoracic esophageal perforations are associated with a pleural effusion or hydropneumothorax. Left pleural effusions often occur because of irritation of the adjacent parietal pleura and pulmonary parenchyma. Hydropneumothorax can occur if the mediastinal pleura ruptures and gas and fluid may enter the pleural space directly from the mediastinum.

7.  Esophageal perforations due to Boerhaaves's syndrome are usually horizontally oriented and located on the right side of the esophagus. True False FALSE: The perforations are vertically oriented and usually occur as 1 to 4cm linear tears on the left posterolateral wall of the esophagus just above the gastroesophageal junction. The distal esophagus is vulnerable because it lacks the supporting mediastinal structures and left side is too because the right side is protected by the descending aorta.

8.  Chagas' disease and achalasia have identical radiographic findings. True False TRUE: In the esophagus, the abnormalities encountered in Chagas' are identical to those in achalasia (i.e. esophageal dilatation with aperistalsis)

9.  The appearance of the esophagus below is typical of what disease process: A. Chagas' disease B. Scleroderma C. Diffuse esophageal spasms D. Achalasia C: This esophagram shows the typical "corkscrew" or "beaded" appearance of diffuse esophageal spasms.

10.  All of the following are usually found in reflux esophagitis EXCEPT: A. ulceration B. mucosal nodularity C. diffuse dilatation D. abnormal motility E. thickened folds C: Some findings that might appear in reflux esophagitis include abnormal motility (25-50%), ulcerations, mucosal nodularity due to edema and inflammation (usually early in the process), thickened folds also due to edema and inflammation, and scarring or strictures (as opposed to diffuse dilatation).

11.  The classic radiographic features of Barrett's esophagitis are high esophageal strictures or deep penetrating ulcers. True False TRUE: The classic radiologic features of Barrett's consist of high esophageal strictures or deep, penetrating ulcers that are also associated with a sliding hiatal hernia and gastroesophageal reflux. The "high" location of these strictures and ulcers is attributed to fact that they occur at the squamocolumnar junction in the midesophagus.

12.  The majority of esophageal carcinomas are of the adenocarcinoma type. True False FALSE: In the esophagus, a majority of carcinomas are of the squamous cell type.

13.  Most infants with tracheal-esophageal fistulas tend to have scaphoid abdomens and absent bowel sounds. True False FALSE: Because the most common form of TEF is esophageal atresia with a distal TEF (87%), most infants with tracheal-esophageal fistulas tend to have round abdomens and active bowel sounds.