This document contains descriptions and images related to the anatomy and imaging of the salivary glands, pharynx, and esophagus. It includes 18 figures showing normal and abnormal anatomy on sialograms, CT, MRI, ultrasound, and barium swallow exams. Examples include images of pleomorphic adenomas, infections, stones, and other pathologies affecting the parotid and submandibular glands. Images of the pharynx and esophagus demonstrate normal swallowing mechanics and abnormalities such as webs, rings, and hernias.

1. 18
DAVID SUTTON

2. DAVID SUTTON PICTURES
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig. 18.1 Digital subtracted images showing
(A) a normal submandibular sialogram and
(B) a normal parotid sialogram. (Courtesy of
Dr P. Chennels.)

4. • Fig. 18.2 Fatty change in the parotids of an
adult-note the low attenuation of the parotid
glands (asterisks). (Courtesy of Richard W.
Whitehouse.)

5. • Fig. 18.3 Anatomy of the parotid an
parapharyngeal spaces.

6. • Fig. 18.4 Heterogenous mass (asterisks) filling the
parapharyngeal space and displacing all the adjacent
spaces. This was a Vth nerve neurofibroma extending
down through the skull base into the parapharyngeal
space.

7. • Fig. 18.5 Pleomorphic adenoma in a minor
salivary gland resulting in a right-sided
parapharyngeal mass.

8. • Fig. 18.6 Stone in submandibular duct shown
on intraoral view. (Courtesy of Miss Ruth
Donaldson.)

9. • Fig. 18.7 Longitudinal oblique sonogram of
submandibular gland showing the main
(Wharton's) duct.

10. • Fig. 18.8 Pleomorphic adenoma. (A) Axial
contrast-enhanced CT through the parotid glands
showing expansion of the left deep lobe and
superficial lobe calcifications. (B) Axial T 2 -
weighted MR image through the parotid glands
showing expansion of the left deep lobe by a
high-signal mass and cystic change in the
superficial lobe but no evidence of calcifications.

11. • Fig. 18.9 Unenhanced coronal T1 -weighted
MR image through the parotid glands
showing a well circumscribed bilobed mass in
the right superficial lobe. Diagnosis:
pleomorphic adenoma.

13. • Fig. 18.11 Axial
contrast-enhanced
CT image of the left
parotid gland (p)
showing a mixed
cystic/solid
enhancing mass
(arrow). Diagnosis:
low-grade carcinoma.

14. • Fig. 18.12 (A) Obstructive sialectasis. Parotid
sialogram demonstrating a non-opaque calculus
in the main duct (between the arrowheads). The
stone is causing obstruction, and the main duct is
dilated. (Courtesy of Dr G. J. S. Parkin.) (B) Parotid
duct stone and dilated main duct demonstrated
by ultrasound.

15. • Fig. 18.13 Axial contrast-enhanced CT image of
the left parotid gland showing a diffuse
enlargement of the deep lobe with loss of the fat
planes around the pterygoid muscles and
effacement of the left side of nasopharynx
(arrow). Diagnosis: deep parotid infection.

16. • Fig. 18.14 Parotid sialogram. (A) Multiple strictures in
the main and in some of the branch ducts. Digital
subtraction image. (B) Parotid sialogram shows an
inflammatory parotid duct stricture (arrow) secondary
to stone disease. Digital subtracted image. (C) Balloon
dilatation of the stricture. (D) Postprocedure sialogram.
(B-D courtesy of Dr F. Carmichael.)

17. • Fig. 18.14 Parotid sialogram. (A) Multiple
strictures in the main and in some of the
branch ducts. Digital subtraction image. (B)
Parotid sialogram shows an inflammatory
parotid duct stricture (arrow) secondary to
stone disease. Digital subtracted image. (C)
Balloon dilatation of the stricture. (D)
Postprocedure sialogram. (B-D courtesy of Dr
F. Carmichael.)

18. • Fig. 18.15 (A) Parotid sialogram showing punctate sialectasis. There are numerous
small collections of contrast medium evenly distributed throughout the gland.
Digital subtraction image. (Courtesy of Dr P. Chennels.) (B) Parotid sialogram
showing globular sialectasis. Collections of contrast medium 1-2 mm in diameter
are evenly distributed throughout the gland (one has been identified with an
arrow). The intraglandular ducts are stunted, irregular and sparse. (C) Parotid
sialogram showing cavitating and destructive sialectasis. There is a large cavity
indicated by the white arrow. There are also numerous small irregular collections
of contrast medium (some indicated by black arrows) throughout the gland,
almost entirely replacing the normal intraglandular duct system. (Courtesy of Dr G.
J. S. Parkin.)

19. • Fig. 18.15 (A) Parotid sialogram showing punctate sialectasis. There are
numerous small collections of contrast medium evenly distributed
throughout the gland. Digital subtraction image. (Courtesy of Dr P.
Chennels.) (B) Parotid sialogram showing globular sialectasis. Collections
of contrast medium 1-2 mm in diameter are evenly distributed throughout
the gland (one has been identified with an arrow). The intraglandular
ducts are stunted, irregular and sparse. (C) Parotid sialogram showing
cavitating and destructive sialectasis. There is a large cavity indicated by
the white arrow. There are also numerous small irregular collections of
contrast medium (some indicated by black arrows) throughout the gland,
almost entirely replacing the normal intraglandular duct system. (Courtesy
of Dr G. J. S. Parkin.)

20. • Fig. 18.16 Axial contrast-enhanced CT image
of the parotid glands showing diffuse
enlargement of both glands, which are of
increased attenuation (arrows). Diagnosis:
infiltration with non-Hodgkin's lymphoma.

21. • Fig. 18.17 (A) Parotid sialogram showing a
deficiency of branch ducts deep within the
gland. (B) Ultrasound scan showing a
hypoechoic mass within the parotid gland.
Diagnosis: pleomorphic adenoma. (Courtesy of Dr
P. Chennels.)

22. • Fig. 18.18 Axial contrast-enhanced CT
through the parotid glands showing a well-
circumscribed dense mass in the left
superficial lobe with calcifications. Diagnosis:
pleomorphic adenoma.

23. • Fig. 18.19 Axial contrast-
enhanced CT image of
the right parotid gland
showing a higher
attenuation non-
enhancing mass
containing calcification
(arrow). Diagnosis:
pleomorphic adenoma.

24. • Fig. 18.20 Parotid sialogram showing a 2.5 cm benign
salivary tumour in the anterior part of the gland,
which is displacing the main duct (white arrows)
downward and the intraglandular ducts (black arrows)
backward. The site of the tumour is devoid of ducts.

25. • Fig. 18.21 Axial
contrast-enhanced CT
image of the right
parotid gland showing
a septated cystic
lesion with a thin
smooth wall.
Diagnosis:
haemorrhaqic
adenolymphoma
(Warthin's tumour).

26. • Fig. 18.22 Axial T 2- weighted MR image
through the parotid glands showing a diffuse
high signal mass expanding the left gland and
involving the adjacent parapharyngeal and
masticator spaces. Diagnosis: lymphangioma.

27. • Fig. 18.23 Left parotid adenocarcinoma-
heterogeneously enhancing mass within the
left parotid gland. (Courtesy of Richard W.
Whitehouse.)

28. • Fig. 18.24 Contrast-enhanced coronal T 1 -
weighted MRI scan of the parotid glands
showing enhancing recurrent tumour (arrow)
in the middle cranial fossa. Diagnosis:
recurrent adenoid cystic carcinoma
demonstrating perineural intracranial
invasion.

29. • Fig. 18.25 (A) Axial contrast-enhanced CT image
of the left parotid gland showing a complex
enhancing mass involving both deep and
superficial lobes. (B) Unenhanced axial CT image
revealing a large calcification (arrow). Diagnosis:
carcinoma ex pleomorphic adenoma.

30. • Fig. 18.26 Endoscopic ultrasound of the oesophagus
showing the layers of the bowel wall. A = mucosa; B =
muscularis mucosa; C = submucosa; D = muscularis
propria; E = adventitia. (Courtesy of Dr K. Harris.)

31. Fig. 18.27 Deep aspiration of barium into the
left lower lobe and

32. • Fig. 18.28 (A) Frontal and (B) lateral views of the normal
hypopharynx after a mouthful of barium has been swallowed. The
large white arrow indicates a valleculum, and the lower white arrow
points to the inferior recess of the pyriform sinus. Arrowheads mark
the aryepiglottic folds. Circumvallate papillae (black arrows). There
are a number of dental fillings.

33. • Fig. 18.29 (A) The normal swallow: 1, tongue
propels bolus to oropharynx; 2, soft palate
moves up and back to close nasopharynx; 3,
posterior pharyngeal wall bulges forward to meet
the soft palate. (B,C.) 4, peristaltic wave runs
down pharynx; 5, hyoid bone elevates; 6,
epiglottis inverts.

34. • Fig. 18.30 Barium swallow showing the hypopharynx. Frontal
view. The epiglottis is outlined by barium (arrows). The epiglottis
and aryepiglottic folds protect the larynx and in so doing bulge into
the pharynx, separating the bolus of barium so that it runs down
two lateral food channels (asterisks).

35. • Fig. 18.31 (A) Pronounced soft palate movement
compensates for weakness of the tongue. (B)
Pronounced tongue movement or (C) superior
pharyngeal constrictor activity compensates for
weakness of the soft palate. (D) Pronounced
movement of the back of the tongue compensates for
weakness of the pharyngeal constrictor muscles. (E)
Pronounced pharyngeal constrictor activity
compensates for weakness of the tongue.

36. • Fig.18.32 Barium
swallow showing the
cervical oesophagus.
Lateral view. The
posterior impression
(arrow) is produced by
failure of the
cricopharyngeus
muscle to relax.

37. • Fig. 18.33 Posterior pharyngeal diverticulum. (A) Frontal view. (B)
Lateral view. Barium fills the diverticulum and then spills over into
the anteriorly displaced oesophagus (arrows). (C) Lateral cervical
oesophageal diverticulum (Kill ian-lamieson diverticulum).

38. • Fig. 18.34 A concentric upper oesophageal
web seen in both the frontal and lateral
projections (arrows). The way in which the
web narrows the lumen is well seen in the
lateral view.

39. • Fig. 18.35 Barium swallow showing the cervical
oesophagus. Lateral view. The small irregular anterior
indentation (arrow) is caused by a venous plexus.
Osteophytes at the C5-6 disc space produce an impression
on the back of the barium column (arrowhead).

40. • Fig. 18.36 Postcricoid web. Lateral view showing
typical thin anterior web (arrowhead). The
lumen is also restricted by cricopharyngeal
spasm posteriorly helping to produce a barium
jet phenomenon.

41. • Fig. 18.37 Postcricoid carcinoma. Lateral view
showing irregular narrowing.

42. • Fig. 18.38 Tertiary contractions of the oesophagus seen as (A) a
rippling length of the oesophagus and consists of a wave of
relaxation fol- of the oesophageal wall or (B) a series of
indentations resembling allowed by a slightly slower wave of
contraction. Should a patient take corkscrew (hence the description
'corkscrew oesophagus').

43. • Fig. 18.39 Condensed image of a normal
swallow. Timescale (x axis) is 30 s, y axis
corresponds to the length of the oesophagus with
the mouth at the top and gastric fundus at the
bottom. M = mouth; D = distance; S = stomach.

44. • Fig. 18.40 Condensed image in a patient with
pharyngeal incoordination leading to transfer
dysphagia, showing fragmentation of the
initial swallowed bolus but normal rate of
transit through the rest of the oesophagus.

45. • Fig. 18.41 Condensed image from a patient
with oesophagitis showing a 'step-delay'
pattern with transient hold up of the bolus in
the middle third of the oesophagus.

46. • Fig. 18.42 Condensed image showing
intraoesophageal reflux retrograde motion of part of
the swallowed bolus from the lower end to the middle
third, with later clearing by a second swallow. M =
mouth; D = distance; S = stomach.

47. • Fig. 18.43 Condensed image in a patient with
achalasia showing stasis of the swallowed
bolus in the middle third of the oesophagus,
with to and fro movement caused by
respiratory excursion.

48. Fig. 18.44 Condensed images of sequential swallows in
a patient with achalasia, obtained with the patient
supine (A) then with the patient semierect (B,C) and
sitting (D), showing improving clearance as the patient
was brought from the supine to the erect position.

49. • Fig. 18.45 Achalasia. The oesophagus is distended. (A)
Intact oesophageal folds pass through the tapered
narrowing, which corresponds to the site of the lower
oesophageal sphincter. On fluoroscopy the impaired
motility will be evident. (B) Sufficient barium has
entered the stomach to coat the fundus and exclude an
infiltrating gastric carcinoma as a cause.

50. • Fig. 18.46 Scleroderma.
Incompetence of the gastro-
oesophageal sphincter
resulting in severe reflux
oesophagitis with
structuring, oedematous
mucosa (mozaic pattern) and
deep ulceration.

51. Fig. 18.47 Midoesophageal diverticulum seen
(A) en face and (B) in profile. (C) Epiphrenic
diverticulum.

52. • Fig. 18.48 The phrenico oesophageal
membrane tethers the distal oesophagus and
stretches or ruptures with the development of
a hiatus hernia. Normally the Z-line lies at the
oesophagogastric junction.

53. • Fig. 18.49 Z-line (between the arrows) marks
the junction of squamous (oesophageal) and
columnar (gastric) epithelium. Gastric rugae
are seen extending up to the line.

54. • Fig. 18.50 The lower end of the oesophagus. (A) The
B-ring may normally be within 2 cm above (as shown
here) or below the hiatus. Thus the oesophageal
vestibule may normally be above, or straddle, the
diaphragmatic hiatus. (B) Small sliding hiatus hernia
with normal B-ring (between arrows).

55. • Fig. 18.51 (A) Schatski's ring (between arrows)
demonstrated by barium swallow. (B) Bread
soaked in barium has been swallowed and is
lodged above the ring (between arrows).

56. • Fig. 18.52 Sliding hiatus
hernia with peptic
oesophagitis. The hiatus
(between arrowheads) is
wide (>3 cm) and at
least three gastric folds
are seen extending
across it. The
oesophageal mucosa is
coarsely granular,
indicating oesophagitis.

57. • Fig. 18.53 (A) Hiatus hernia with an asymmetric stricture found to be benign on
biopsy. Above the stricture are a number of ulcers together with transverse folds
and pseudodiverticula produced by spasm and scarring. Mucosal erosions (arrows)
are present in the oesophagus above this ulcerated segment. (B) Feline
oesophagus. These fine mucosal folds are a transient finding produced by
contraction of the muscularis mucosa. A similar appearance may be seen in cats. It
is usually a normal variant but may be associated with gastro-oesophageal reflux.

58. • Fig. 18.54 (A) Annular peptic stricture at the oesophagogastric junction. Areae gastricae
pattern is present below the stricture. (B) Benign peptic stricture above a hiatus hernia. The
stricture has smooth tapered margins. (C) Benign peptic stricture. Asymmetric ulceration and
scarring has produced a stricture with irregular and shouldered margins resembling a
carcinoma. Erosions on oesophageal folds give them a lobular margin resembling varices
(arrows). (D) Peptic oesophagitis with a long tapered stricture resulting from the presence of
a nasogastric tube.

59. • Fig. 18.54 (A) Annular peptic stricture at the oesophagogastric junction. Areae gastricae pattern is
present below the stricture. (B) Benign peptic stricture above a hiatus hernia. The stricture has
smooth tapered margins. (C) Benign peptic stricture. Asymmetric ulceration and scarring has
produced a stricture with irregular and shouldered margins resembling a carcinoma. Erosions on
oesophageal folds give them a lobular margin resembling varices (arrows). (D) Peptic oesophagitis
with a long tapered stricture resulting from the presence of a nasogastric tube.

60. • Fig. 18.55 Barrett's oesophagus.
Ulceration (arrows) at the
squamocolumnar junction,
below which is a fine reticular
pattern. This resembles the
areae gastricae pattern of the
stomach, and i s produced by
islands of columnar mucosa. + =
Pool of barium; H = hiatus
hernia.

61. • Fig. 18.56 Candida
oesophagitis. (A)
Mucosal plaques. (B)
Extensive mucosal
nodularity.

62. • Fig. 18.57 Corrosive stricture. Long
stricture extending up to the
midoesophagus resulting from
swallowing lye as a child.

63. • Fig. 18.58 Intramural pseudodiverticulosis. (A) Multiple flask-shaped
projections produced by barium entering dilated oesophageal glands. (B)
Midoesophageal stricture with small flask-shaped projections. (C) A few
pseudodiverticula associated with a benign peptic stricture.

64. • Fig. 18.59 (A) The radiographic
features of a sliding hiatus hernia. H=
hiatus, more than 3 cm wide with at
least three gastric folds seen
extending across the hiatus; S =
stomach forming the hernia; B = B-
ring, the oesophagogastric junction; V
= vestibule. The A-ring is not visible.
(B) CT scan showing the Crura of the
diaphragm (arrows) separated by 28
mm (normal is 15 mm or less). The
fundus of the stomach is seen
herniating through the diaphragmatic
hiatus. (C) Normal CT of
diaphragmatic hiatus for comparison.
Crura of the diaphragm are arrowed.

65. • Fig. 18.59 (A) The radiographic features of a sliding
hiatus hernia. H= hiatus, more than 3 cm wide with at
least three gastric folds seen extending across the
hiatus; S = stomach forming the hernia; B = B-ring, the
oesophagogastric junction; V = vestibule. The A-ring is
not visible. (B) CT scan showing the Crura of the
diaphragm (arrows) separated by 28 mm (normal is 15
mm or less). The fundus of the stomach is seen
herniating through the diaphragmatic hiatus. (C)
Normal CT of diaphragmatic hiatus for comparison.
Crura of the diaphragm are arrowed.

66. • Fig. 18.60 Rolling
(paraoesophageal)
hiatus hernia. The
gastric fundus (H) lies
alongside the lower
oesophagus (0).

67. • Fig. 18.61 (A) Angelchik prosthesis: a silicon ring
that is placed around the intra-abdominal
segment of the oesophagus to secure its position
below the diaphragm. In this patient the ring has
slipped down over the stomach and eroded into
the stomach. Barium has leaked from the
stomach around the prosthesis. (B) Radiological
appearance of a failure of a fundoplication.
Anatomical drawings top row, barium meal
appearances bottom row. 1, Normal
postoperative appearance; 2, complete
disruption of wrap with recurrence of hiatus
hernia; 3, wrap intact but herniates through
diaphragmatic hiatus; 4, stomach slips up
through wrap and bulges above diaphragm; 5,
stomach slips up through wrap but remains
below diaphragm. (C) Stomach slips up through
wrap and bulges above diaphragm. Wrap is
arrowed.

68. • Fig. 18.61 (A) Angelchik prosthesis: a silicon
ring that is placed around the intra-
abdominal segment of the oesophagus to
secure its position below the diaphragm. In
this patient the ring has slipped down over
the stomach and eroded into the stomach.
Barium has leaked from the stomach around
the prosthesis. (B) Radiological appearance
of a failure of a fundoplication. Anatomical
drawings top row, barium meal appearances
bottom row. 1, Normal postoperative
appearance; 2, complete disruption of wrap
with recurrence of hiatus hernia; 3, wrap
intact but herniates through diaphragmatic
hiatus; 4, stomach slips up through wrap and
bulges above diaphragm; 5, stomach slips up
through wrap but remains below diaphragm.
(C) Stomach slips up through wrap and
bulges above diaphragm. Wrap is arrowed.

69. • Fig. 18.62 Inflammatory polyp (arrows). The
polyp lies at the end of a gastric fold
(asterisk).

70. • Fig. 18.63 Leiomyoma. An echopoor mass
(between arrows) is continuous with the layer
of the muscularis propria.

71. • Fig. 18.64 Leiomyoma of the oesophagus. Two
views showing features typical of an intramural
or extrinsic lesion. There is a broad-based filling
defect bulging into, and widening the lumen of
the oesophagus.

72. • Fig. 18.65 Early oesophageal carcinoma. (A) A
plaque lesion is seen in profile (arrowheads). (B)
En face there is a central ulcer (asterisk) with a
nodular margin (arrows).

73. • Fig. 18.66 Carcinoma of the
oesophagus. (A) Advanced stricturing
lesion with mucosal destruction and
'shouldering'. (B) Shallow ulcer with a
tumour ring. (Courtesy of Dr D. A.
Ward.) (C) Two tumour nodules.
(Courtesy of Dr R. Edwards.) (D) An
irregular polypoidal intraluminal filling
defect which is causing obstruction. (E)
Oesophageal carcinoma with
submucosal extension simulating
varices; however, unlike varices the
width of the elongated filling defects
was uninfluenced by the degree of
oesophageal distension. (F) Early
oesophageal carcinoma. Plaque-like
squamous carcinoma (large arrows)
with a small satellite lesion caused by
lymphatic spread (small arrow).

74. • Fig. 18.66 Carcinoma of the
oesophagus. (A) Advanced
stricturing lesion with mucosal
destruction and 'shouldering'. (B)
Shallow ulcer with a tumour ring.
(Courtesy of Dr D. A. Ward.) (C) Two
tumour nodules. (Courtesy of Dr R.
Edwards.) (D) An irregular
polypoidal intraluminal filling defect
which is causing obstruction. (E)
Oesophageal carcinoma with
submucosal extension simulating
varices; however, unlike varices the
width of the elongated filling defects
was uninfluenced by the degree of
oesophageal distension. (F) Early
oesophageal carcinoma. Plaque-like
squamous carcinoma (large arrows)
with a small satellite lesion caused
by lymphatic spread (small arrow).

75. • Fig. 18.66 Carcinoma of the
oesophagus. (A) Advanced
stricturing lesion with mucosal
destruction and 'shouldering'. (B)
Shallow ulcer with a tumour ring.
(Courtesy of Dr D. A. Ward.) (C)
Two tumour nodules. (Courtesy of
Dr R. Edwards.) (D) An irregular
polypoidal intraluminal filling
defect which is causing
obstruction. (E) Oesophageal
carcinoma with submucosal
extension simulating varices;
however, unlike varices the width
of the elongated filling defects
was uninfluenced by the degree
of oesophageal distension. (F)
Early oesophageal carcinoma.
Plaque-like squamous carcinoma
(large arrows) with a small
satellite lesion caused by
lymphatic spread (small arrow).

76. • Fig. 18.67 Staging of oesophageal carcinoma by endoscopic
ultrasound. (A) Diagram illustrating T staging. T1, Tumour limited to
mucosa and submucosa. T2, Tumour infiltrates the muscularis
propria. T3, Tumour involves adventitia. T4, Tumour invades
adjacent structures, i.e. aorta, trachea, pericardium. (B) Stage T2.
The muscularis propria has not been breached (black arrows). (C)
Stage T2N1. The muscularis propria has not been breached.
Adjacent involved malignant lymph nodes (N). Malignant nodes are
round, hypoechoic and well defined with loss of internal structure.
(D) Stage T4. Tumour has breached the muscularis propria and is
invading the aortic wall (arrow). Ao = aorta; T = tumour; N =
metastatic lymph node. (Courtesy of Dr K. Harris.)

77. • Fig. 18.67 Staging of oesophageal carcinoma by endoscopic
ultrasound. (A) Diagram illustrating T staging. T1, Tumour limited to
mucosa and submucosa. T2, Tumour infiltrates the muscularis
propria. T3, Tumour involves adventitia. T4, Tumour invades
adjacent structures, i.e. aorta, trachea, pericardium. (B) Stage T2.
The muscularis propria has not been breached (black arrows). (C)
Stage T2N1. The muscularis propria has not been breached.
Adjacent involved malignant lymph nodes (N). Malignant nodes are
round, hypoechoic and well defined with loss of internal structure.
(D) Stage T4. Tumour has breached the muscularis propria and is
invading the aortic wall (arrow). Ao = aorta; T = tumour; N =
metastatic lymph node. (Courtesy of Dr K. Harris.)

78. • Fig. 18.68 Carcinoma of the oesophagus. (A) Carcinoma invading
the trachea (arrow). A nasogastric tube is in situ, causing the high
density artefact. (B) Thickened oesophageal wall but no aortic
invasion as there is an intact fat plane between oesophagus and
aorta. (C) Tumour (asterisk) surrounds the aorta over an arc of just
under 90°, which is indeterminate for invasion. (D) Tumour
surrounds the aorta over an arc of >90' and obliterates the triangle
of fak between the spine aorta and oesophagus. Both of these
features suggest aortic invasion

79. • Fig. 18.68 Carcinoma of the oesophagus. (A) Carcinoma invading
the trachea (arrow). A nasogastric tube is in situ, causing the high
density artefact. (B) Thickened oesophageal wall but no aortic
invasion as there is an intact fat plane between oesophagus and
aorta. (C) Tumour (asterisk) surrounds the aorta over an arc of just
under 90°, which is indeterminate for invasion. (D) Tumour
surrounds the aorta over an arc of >90' and obliterates the triangle
of fak between the spine aorta and oesophagus. Both of these
features suggest aortic invasion

80. • Fig. 18.69 Enlarged subcarinal (white arrow)
and paraoesophageal (black arrows) lymph
nodes in a patient with advanced oesophageal
carcinoma. Note dilated oesophagus with air
fluid level proximal to the tumour.

81. • Fig. 18.70 Endoscopic ultrasound. A small
amount of ascites at the margin of the left
lobe of the liver.

82. • Fig. 18.71 Nitinol wallstent being deployed for
an obstructing midoesophageal carcinoma.
(Courtesy of Dr M. Sheridan.)

83. • Fig. 18.72 Spindle cell
sarcoma. A bulky polypoid
tumour arising in the
midoesophagus.

84. • Fig. 18.73 Lower oesophageal obstruction
produced by impaction of a large meat bolus.

85. • Fig. 18.74 (A) Mallory-
Weiss syndrome. Tear
in the oesophagus at its
lower end caused by
vomiting. Barium
(arrows) has tracked
through the defect to lie
beneath the mucosa. (B)
Mucosal tear and
intramural haematoma
spreading along the
length of one side of the
oesophagus. The patient
had swallowed a meat
bone.

86. • Fig. 18.75 Oesophageal varices. Typical
worm-like filling defects.

87. • Fig. 18.76 Confluence of
pulmonary veins behind
the left atrium producing
an extrinsic impression on
the anterior oesophageal
wall (arrows).

88. • Fig. 18.77 Oesophageal displacement by a dilated
aorta. (A) Lateral view shows narrowing at the gastro-
oesophageal junction resembling achalasia but caused
by displacement, as the oesophagus is of normal width
in the frontal view (B).

89. • Fig. 18.78 Aberrant right
subclavian artery producing
characteristic extrinsic defect
(arrows) of the oesophagus just
above the level of the aortic
arch. Left anterior oblique view.