2013年5月11日土曜日
らせん階段：NEJMの最新イメージ
さて最新のNEJMのイメージ画像である。このらせん様の構造はいったいなんであろうか？
で、今年も登場である。
Images in Clinical Medicine
Corkscrew Esophagus
N Engl J Med 2014; 371:e33November 20, 2014
A 74-year-old man presented with a 30-year
history of intermittent dysphagia and regurgitation, which his doctor
had initially referred to as a “hysterical reaction.” The patient
reported having symptoms of retrosternal fullness leading to
regurgitation every 2 to 3 months; he had no associated chest pain,
weight loss, or change in symptom frequency over this 30-year period. A
proton-pump inhibitor had been prescribed 3 years before presentation
and did not provide relief. The patient was referred for evaluation. A
barium-swallow examination showed two diverticula proximal to the marked
corkscrew appearance of the distal esophagus (Panel A). The lumen was
identified on endoscopy, but advancement of the endoscope was not
possible owing to esophageal tortuosity (Panel B). Manometry was
suggested to assess for diffuse esophageal spasm, but it could not be
performed. The patient's symptoms remain unchanged, with infrequent
dysphagia. He is relatively asymptomatic between episodes and has
declined the use of other therapies, such as smooth-muscle relaxants.
Chin Yit Soo, M.B., Ch.B.University of Edinburgh, Edinburgh, United Kingdom
Jonathan Fletcher, M.R.C.P.
Borders General Hospital, Melrose, United Kingdom
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