[Endosonographic picture of the esophagus and paraesophageal lymph nodes in subjects with oesophagitis].
Echocardiographic examination (EUS) gives a good overview of the structure of the whole oesophagus and the paraoesophageal space. To the EUS picture of reflux oesophagitis and normal EUS picture of paraoesophageal lymph nodes relatively few publications are devoted. The objective of the present work is to describe ultrasonographic (USG) signs of endoscopically and histologically confirmed oesophagitis (grade III and IV) and compare them with a control group, describe the USG picture of paraoesophageal lymph nodes in subjects with oesophagitis and in controls. The authors examined, using an Olympus GIF-UM20 instrument with a radial probe (7.5 ad 12MHz), 30 patients with endoscopically and histologically confirmed oesophagitis (m/f 15/15) and a control group of 40 subjects (m/f 21/19) with a negative endoscopic and histological finding of the oesophagus, cardia and stomach, a USG finding on the hepatobiliary system and X-ray of the lungs. They assessed the thickness of the oesophageal wall and evaluated its USG structure. The authors examined also the paraoesophageal lymph nodes (number, size, shape, structure) in both groups. In oesophagitis they found in all instances less distinct outlines of the three inner USG layers of the oesophageal wall. The oesophageal wall in oesophagitis was significantly thicker than in controls (6.9 +/- 1.7 mm and 3.2 +/- 0.7, alpha=0.05). The paraoesophageal nodes could be evaluated in 21, i.e. 70% patients with oesophagtis and in 23 of 40, i.e. 30% of the controls. The mean number of lymph nodes in patients with oesophagitis was 2.1, in controls 1.8. The percentage of triangular and oval lymph nodes was 52 in oesophagitis, i.e 48%, in controls 57, i.e. 43%. The central echo was apparent in triangular/oval lymph nodes in 91/40%, in controlsin 85 and 30%. The mean dimensiion of triangular/oval lymph nodes in oesophagitis and controls was 7.3 +/- 2.3/6.3 +/- 1.6 mm and 8.5 +/- 2.3/6.5 +/- 1.7 mm. The differences of parameters recorded in lymph nodes in the two groups are not statistically significant.


CONCLUSIONS
The oesophageal wall in portions with oesophagitis is significantly thicker. The outlines of the inner three USG layers are not sharp. There is an association between oesophagitis and the number, size, shape and structure of paraoesophageal lymph nodes. The majority of paraoesophageal lymph nodes in both groups is above the 5 mm borderline. When malignant infiltration of the lymph nodes is suspected, thin needle aspiration biopsy under EUS control is indicated.
Novotný
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III. interní-gastroenterologická klinika FN MU, Brno-Bohunice.
Münzová
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Dítĕ
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D019160:Endosonography; D004941:Esophagitis / Q000000981:diagnostic imaging*; D004947:Esophagus / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged