食道結核の画像診断

Imaging Diagnosis of Esophageal Tuberculosis

要旨●食道結核はまれな疾患であり，大半は傍気管・縦隔内の結核性リンパ節炎の波及によるため好発部位は中部食道である．内視鏡像はリンパ節炎の圧排による粘膜下腫瘍様隆起から自壊・排膿を経て潰瘍形成ならびに隆起の平坦化へと経時的に変化していくことが特徴的である．鑑別診断として粘膜下腫瘍様の食道癌や感染症，炎症性疾患が挙げられる．内視鏡下生検での正診率は低く，確定診断には培養検査やPCR検査などが必要で，最終的には総合的な判断が求められる．診断が遅れると致死的になることもあるため，その内視鏡像の特徴を把握しておくことが肝要である．

　Esophageal tuberculosis is a rare presentation that primarily involves the middle esophagus due to the spread of tuberculous lymphadenitis in paratracheal and mediastinal regions. Characteristic endoscopic findings include submucosal tumor-like elevations caused by lymphadenitis, which progress to self-rupture, purulent discharge, ulcer formation, and flattening over time. Differential diagnosis includes submucosal tumor-like esophageal cancer, infections, and inflammatory diseases. The diagnostic accuracy of endoscopic biopsy is low, and definitive diagnosis requires culture and polymerase chain reaction. The definite diagnosis of esophageal tuberculosis should be based on comprehensive assessment, and understanding the characteristics of endoscopic images is critical, given that delayed diagnosis can be fatal.