PMC3355650_01
Radiography of the esophagus before and after treatment. a Before any treatment, the esophagus was severely stenosed in the upper thoracic area. Arrows represent protruding sac-like barium collections. b Radiography of the esophagus 3 months after commencement of oral administration of anti-fungal medicine indicated that the flow of the swallowed barium was greatly improved during the administration of anti-fungal medicine, although there still remained a clumped filling defect in the upper thoracic esophagus. c On the anal side of the narrowing, very small (1-3 mm) multiple flask-shaped outpouchings (arrows), representing multiple pseudodiverticula, were diffusely distributed in the esophagus.
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F1
The barium barely thread through a 5- to 6-cm-long segment of severe narrowing, and the anal side of the narrowing only slightly appeared on the radiography (fig. 1a). Radiography showed significant improvement in the flow of swallowed barium, although there still remained a clumped filling defect in the upper thoracic esophagus (fig. 1b). It was also revealed by repeated radiography that very small (1-3 mm), multiple, flask-shaped outpouchings were diffusely distributed in the esophagus on the anal side of the narrowing (fig. 1c).
Endoscopic images of the esophagus before treatment. a, b On the oral side of the stenosis, the esophageal mucosa was occupied by honeycomb-like multiple depressions. c Severe fibrotic stenosis was observed 26 cm from the incisors. d Along the anal side of the stenotic region, large numbers of tiny orifices (arrows) were distributed.
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F2
On the oral side of the stenosis, the esophageal mucosa was occupied by honeycomb-like multiple depressions (fig. 2a, b). A thin-caliber endoscope (6-mm outside diameter; Olympus XP260N) barely passed through this narrowed region where the esophageal mucosa was not ulcerated (fig. 2c). Then a large number of tiny orifices corresponding to pseudodiverticula were identified along the anal side of the stenotic region (fig. 2d).
Endoscopic images before and after continuous oral administration of anti-fungal medicine. a, b Prior to the anti-fungal medicine, the esophageal lumen was severely stenosed, and a white, thick, creamy liquid suggestive of pus emerging from the orifices was detected endoscopically. c, d Three months after commencement of the treatment, the esophageal stenosis was considerably improved and the pus from the orifices had disappeared.
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F3
EBD therapy, and these treatments greatly improved his dysphagia. EGD revealed significant improvement of the esophageal constriction and disappearance of the pus, although multiple small depressions remained in the entire esophagus (fig. 3c, d).