External esophageal pressure and stretch

Introduction to external esophageal pressure and traction The esophagus passes through and spans many structures and organs during its travel. Most of the esophagus is located in the posterior mediastinum. The upper and lower ends are relatively fixed, and the middle can move. The esophagus passes through and spans many structures and organs near the structure and organs. The lesion can mechanically affect the esophagus, causing external pressure and traction, resulting in ectopic and deformation, which can cause difficulty in swallowing in severe cases. basic knowledge The proportion of illness: 0.005%-0.006% Susceptible people: no special people Mode of infection: non-infectious Complications: difficulty swallowing

Extra-esophageal pressure and traction cause

(1) Causes of the disease

Most of the esophagus is located in the posterior mediastinum. The upper and lower ends are relatively fixed, and the middle can move. The esophagus passes through and crosses many structures and organs during its stroke. The lesions of nearby structures and organs can mechanically affect the esophagus, causing external pressure and traction. Pulling, resulting in ectopic and deformation, can cause difficulty in swallowing in severe cases.

(two) pathogenesis

1. When the cervical hypertrophic osteoarthrosis is serious, the epiphysis can cause difficulty in swallowing due to the neck esophagus. The patient feels that the solid food has a short pause in the upper esophagus when swallowing, and the predilection site of the hypertrophic osteoarthrosis of the cervical vertebra is in the fifth. 6,7 cervical vertebrae, swallowing in the posterior esophageal wall, one to several limited indentations can be seen, generally do not block the esophagus, only when the lesion is significant, incomplete obstruction, esophageal mucosa is normal, esophagoscopy can be seen the corresponding level The posterior wall of the esophagus has a notch and obstruction, and the appearance of the mucosa is normal. The epiphysis is removed from the cervical vertebra, and the difficulty in swallowing can completely disappear.

2. Esophageal lesions caused by thyroid enlargement The thyroid gland is located in the anterior part of the neck. The front and sides of the upper end of the trachea are divided into the left and right lobe and the isthmus connecting the two lobe. The inner side of the left and right lobe and the larynx, trachea, The esophagus is in contact with each other. Therefore, the thyroid enlargement causes the esophagus to be displaced and the trachea is displaced and compressed. One side of the thyroid gland is obviously enlarged, and the esophagus and trachea can be displaced to the opposite side.

3. Esophageal changes caused by lung and pleural lesions The thoracic esophagus is a mediastinal viscera. Any lung and pleural lesions that can cause mediastinal shift can also cause esophageal displacement, such as space-occupying lesions on one side of the chest, such as massive pleural effusion. Liquid, high-pressure pneumothorax, giant sputum and tumor, can shift the mediastinum and esophagus to the healthy side; one side of the atelectasis, pulmonary sclerosis, severe pleural hypertrophy can cause the mediastinum and esophagus to shift to the affected side, chronic inflammation of the lungs For example, tuberculosis and chronic lung suppuration may involve the mediastinal pleura and cause fibrosis of the lung tissue, causing the esophagus to be displaced to the contracted portion of the fiber.

4. Aortic aneurysm can occur in various parts of the aorta. According to the location and size of the aneurysm, the esophagus produces different directions of compression. The aortic aneurysm usually occurs in the ascending aorta and the aortic arch. The ascending aorta tends to move forward. , bulging to the right, does not affect the esophagus; aneurysms of the aortic arch can compress the esophagus, making it to the right, shifting backward.

Arteriosclerosis can cause the aorta to stretch and distort. Because of the fibrous tissue between the esophagus and the descending aorta, the esophagus is flexed and displaced with the tortuous descending aorta.

Extra-esophageal pressure and traction prevention

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Extra-esophageal pressure and traction complications Complications, difficulty swallowing

Structural and organ lesions can mechanically affect the esophagus, causing external pressure and traction, resulting in ectopic and deformed conditions, which can lead to difficulty in swallowing in severe cases.

Extra-esophageal pressure and traction symptoms Common symptoms Goiter, pleural effusion, cervical hypertrophy, dysphagia, abscess, mediastinal lesions

1. Esophageal lesions caused by spinal lesions The sixth cervical vertebrae to the sternal notch plane is a cervical esophagus, which is very close to the cervical vertebrae. Only the anterior fascia and connective tissue are separated from the cervical vertebrae, and the cervical esophagus moves in a small range. Therefore, the cervical vertebrae lesions tend to compress the esophagus, and the common cervical erosion of the esophagus is hypertrophic osteoarthrosis, tuberculosis, osteomyelitis and tumors.

When the cervical hypertrophic osteoarthrosis is severe, the osteophytes can compress the cervical esophagus and cause difficulty in swallowing. The patient feels that the solid food has a short pause in the upper esophagus when swallowing, and the prone site of cervical hypertrophic osteoarthrosis is in the fifth, sixth, 7 cervical vertebrae, when swallowing in the posterior esophageal wall, one to several limited indentations can be seen, generally do not block the esophagus, only when the lesion is significant, incomplete obstruction, esophageal mucosa is normal, esophagoscopy can be seen the corresponding level of esophagus There are notch and obstruction on the posterior wall, the appearance of the mucosa is normal, the epiphysis is removed from the cervical vertebrae, and the dysphagia can be completely disappeared. The cervical spondylosis, the abscess formed by osteomyelitis or the tumor can also compress the posterior wall of the esophagus, and the posterior wall of the esophagus is displayed when swallowing. Curved or wavy impressions, severe cases can show that the tincture passes slow or incomplete obstruction.

The sternal notch is below the thoracic esophagus, which is slightly distant from the thoracic vertebrae. The mild thoracic lesions generally do not affect the changes of the esophagus. However, severe thoracic lesions, such as various deformities caused by excessive curvature of the spine, can cause chest. Displacement of the esophagus, a massive abscess formed by thoracic tuberculosis or osteomyelitis can also push the esophagus.

2. Esophageal lesions caused by thyroid enlargement The thyroid gland is located in the anterior part of the neck. The front and sides of the upper end of the trachea are divided into the left and right lobe and the isthmus connecting the two lobe. The inner side of the left and right lobe and the larynx, trachea, The esophagus is in contact with each other. Therefore, the thyroid enlargement causes the esophagus to be displaced and the trachea is displaced and compressed. One side of the thyroid gland is obviously enlarged, and the esophagus and trachea can be displaced to the opposite side.

3. Esophageal changes caused by lung and pleural lesions The thoracic esophagus is a mediastinal viscera. Any lung and pleural lesions that can cause mediastinal shift can also cause esophageal displacement, such as space-occupying lesions on one side of the chest, such as massive pleural effusion. Liquid, high-pressure pneumothorax, giant sputum and tumor, can shift the mediastinum and esophagus to the healthy side; one side of the atelectasis, pulmonary sclerosis, severe pleural hypertrophy can cause the mediastinum and esophagus to shift to the affected side, chronic inflammation of the lungs For example, tuberculosis and chronic lung suppuration may involve the mediastinal pleura and cause fibrosis of the lung tissue, causing the esophagus to be displaced to the contracted portion of the fiber.

4. Mediastinal changes caused by mediastinal thoracic esophagus in the posterior mediastinum, many mediastinal lesions, such as retrosternal goiter, dermoid cyst, teratoma, pericardial cyst, neurofibromatosis, lymphoma, mediastinal abscess, post-traumatic hematoma, radiation Posterior mediastinal fibrosis, post-operative fibrosis, etc. can cause displacement of the esophagus due to compression and traction.

5. Cardiovascular disease caused by esophageal lesions Cardiovascular disease on the esophagus is in the middle and lower part of the esophagus.

Aortic aneurysm can occur in various parts of the aorta. According to the location and size of the aneurysm, the esophagus produces different directions of compression. The aortic aneurysm mostly occurs in the ascending aorta and the aortic arch. The ascending aorta tends to move forward. The right bulge does not affect the esophagus; the aneurysm of the aortic arch can compress the esophagus to shift it to the right and backward.

Arteriosclerosis can cause the aorta to stretch and distort. Because of the fibrous tissue between the esophagus and the descending aorta, the esophagus is flexed and displaced with the tortuous descending aorta.

Esophageal changes are very helpful in the diagnosis of ventricular hypertrophy. Esophageal angiography has become one of the essential examination steps to judge the various compartments of the heart, especially the enlargement of the left atrium. When the left atrium is enlarged, the esophagus is pressed backwards. Shift to the right.

In addition, some congenital vascular malformations, such as the right aorta, bilateral aortic arch, abnormal right subclavian artery, and pericardial effusion can cause esophageal compression or displacement.

Esophageal pressure and traction examination

1. The most common site of cervical hypertrophic osteoarthrosis is in the 5th, 6th, and 7th cervical vertebrae. When swallowing, the posterior esophageal wall can be seen. There are one or several limited indentations, which usually do not block the esophagus, only when the lesion is significant. Only incomplete obstruction occurred, and the esophageal mucosa was normal.

2. Cervical tuberculosis, an abscess or tumor formed by osteomyelitis can also compress the posterior wall of the esophagus. When swallowing, it shows that the posterior wall of the esophagus is curved or wavy. In severe cases, the expectorant can be slow or not obstructed.

3. The change of esophagus is very helpful for the diagnosis of ventricular hypertrophy. Esophageal angiography has become one of the essential examination steps for judging the various compartments of the heart, especially the left atrium. When the left atrium is enlarged, the esophagus is pressed. After that, shift to the right.

Esophageal external pressure and traction diagnosis

The main basis for the diagnosis of external esophageal pressure and traction is:

1. Different clinical manifestations and symptoms.

2. Esophageal X-ray barium angiography.

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