Differential diagnosis of early esophageal cancer

In the differential diagnosis of early esophageal cancer, the following common esophageal diseases should be considered first to avoid misdiagnosis.

(1) Early esophageal varices. Early esophageal cancer in the lower 1/3 of the esophagus should be differentiated from this disease. X-ray manifestations: esophageal varices. When barium is filled, the edge of the esophagus becomes irregular, and the folds of the esophageal mucosa lose their longitudinal strip arrangement, forming a soap bubble or snake skin-like change. The flow rate of esophageal barium slows down, and local barium retention occurs, but the esophageal dilation is still good.

(2) Benign tumors. Benign tumors of the esophagus are relatively rare. The most common benign tumor is leiomyoma. X-ray manifestations: mainly filling defects with smooth edges, intact mucosa, no obvious changes in relaxation, and sometimes mucosal extrusion.

(3) Esophageal diverticula. Esophageal diverticula are commonly traction diverticula, which are often found in the middle 1/3 of the esophagus. They are mainly caused by infection of the bifurcation lymph nodes, healing of inflammation, and contraction of the esophagus. X-ray manifestations: They are often in the middle 1/3 of the esophagus, appearing as small curtain-shaped or small round protrusions, with a wide base that is easy to empty and intact mucosa.

(4) Esophagitis. Esophagitis is mainly caused by trauma or inflammatory infection, followed by fungal disease, which has also been reported frequently in recent years.

X-ray manifestations: extensive esophageal mucosal wrinkles and interruptions, and ulcers. The esophagus is irritated by inflammation, and the third peristaltic wave often appears. In severe cases, pseudo-filling defects may occur, leading to esophageal lumen stenosis. It is difficult to distinguish from early esophageal cancer, so the medical history should be carefully inquired, and endoscopic examination should be performed if necessary.

(5) Calcified lymph nodes in the hilum and mediastinum. Calcified lymph nodes in the hilum and mediastinum are often easily overlapped with the esophageal mucosa during imaging, similar to a small niche. Therefore, during imaging, a chest examination should be performed routinely to determine whether there are enlarged lymph nodes or calcified lesions in the hilum and mediastinum that overlap or compress the esophagus, causing misdiagnosis.

(6) Bubbles in the esophagus. When performing esophageal mucosal contrast imaging, the patient often swallows air, and the bubbles form a small negative shadow on the mucosal surface, similar to a small ineffective defect. However, the false filling defect formed by the bubbles is temporary and will disappear during the next examination, making differential diagnosis relatively easy.