びらん・潰瘍を呈する食道病変のX線診断

Radiological Diagnosis for Esophageal Erosion and Ulcer

要旨●食道にびらん・潰瘍を伴う病変を認めた場合には，腫瘍性か非腫瘍性かを鑑別し，特に非腫瘍性と診断した場合には病歴を詳細に聴取する必要がある．また腫瘍性，癌と診断するために，X線造影検査では，食道表在癌の正面像と側面像の特徴を十分理解しておくことが必要である．正面像では陥凹の辺縁と内部の形態やバリウムの付着性，側面像では壁の伸展不良に伴う変形の有無が，癌と良性のびらん・潰瘍の鑑別において有用であった．食道表在癌では，陥凹内は癌組織で構成され表面が癌性びらんを呈しているため，良性びらんと比較してバリウムの付着が亢進していた．また良性びらん・潰瘍では，全身性疾患や他の消化管疾患の特徴的な形態や配列などを描出するだけでなく，経過中の形態変化を客観的に評価するうえでもX線造影検査は有用であった．

　When making a differential diagnosis of esophageal erosion and ulceration using X-ray examination, a sufficient understanding of the morphological characteristics of the anteroposterior and lateral views of superficial carcinomas of the esophagus is crucial. Findings on the anteroposterior view that help differentiate malignant and benign erosions from ulceration include the margins and interior morphology of the depressions and the differences in barium adhesiveness in the depression. On the other hand, the useful findings on the lateral view are the presence or absence of deformation accompanying poor wall extensibility. Because superficial carcinomas of the esophagus exhibit malignant erosions within the depression, barium adhesiveness is more advanced in such erosions than in benign erosions. X-ray examinations of benign erosions and ulceration are useful not only for rendering the shape and arrangement of the erosion and ulceration that are characteristic of systemic disorders and other gastrointestinal diseases but also for objectively evaluating changes throughout the patient's course.