Published in:
01-05-2019 | Foreign Body Aspiration | Classics in Abdominal Radiology
The “sigmoid” esophagus
Published in: Abdominal Radiology | Issue 5/2019
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The “sigmoid esophagus” metaphorically describes the dilated, debris-filled esophagus in end-stage achalasia. The body of the esophagus begins to sag inferiorly, giving it a tortuous, sigmoid appearance resembling that portion of the distal colon (Fig. 1) [3]. This characteristic appearance can be seen on multiple imaging modalities. Chest radiography, for example, can reveal a widened mediastinum, a mediastinal air-fluid level, or absence of a gastric air bubble (Fig. 2) [1]. An esophagram highlights the degree of stasis and profound dysmotility [1]. CT offers ancillary findings such as tracheobronchial tree compression, and the frequently associated sequela of aspiration (Fig. 3) [1].
Fig. 1
Sigmoid colon with a tortuous course as it approaches the rectum. The dilated, circuitous course of the esophagus in end-stage achalasia closely resembles this appearance, hence the term “sigmoid esophagus”. Image from
http://samedicalgraphics.com/case-specific-exhibits/
Fig. 2
Chest radiograph demonstrating a widened mediastinum with the presence of a nasogastric tube reflecting the tortuous, dilated, and elongated esophagus. No gastric bubble is identified, a nonspecific sign that can be associated with achalasia
Fig. 3
A coronal reformatted unenhanced CT image of the chest in the same patient, as shown in Fig. 2, clearly delineates the contour of the dilated, tortuous, esophagus with its “sigmoid” appearance. The body of the esophagus is filled with debris, sags inferiorly, and abuts the each hemidiaphragm
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