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Radiol Bras. 2016 Nov-Dec;49(6):358-362. doi: 10.1590/0100-3984.2015.0141.

Radiological findings in megaesophagus secondary to Chagas disease: chest X-ray and esophagogram.

Author information

1
MsC, Doctoral Student in the Department of Diagnostic Imaging of the Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), Interventional Radiologist at the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
2
MD, Radiologist at Documenta - Hospital São Francisco, Doctoral Student in the Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.
3
PhD, Radiologist at Documenta - Hospital São Francisco, Ribeirão Preto, SP, Brazil.
4
PhD, Interventional Radiologist, Department of Diagnostic Imaging of the Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.
5
PhD, Radiologist, Department of Diagnostic Imaging of the Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.

Abstract

in English, Portuguese

OBJECTIVE:

To identify and classify the radiographic patterns of megaesophagus in Chagas disease, as seen on esophagograms and chest X-rays.

MATERIALS AND METHODS:

This was a prospective study of 35 patients diagnosed with esophageal disease via manometry. The changes found on esophagograms were stratified according to Rezende's classification, divided into four categories (grades I through IV) determined by the degree of dilatation and impairement of esophageal motility. We subsequently correlated that ranking with the chest X-ray findings: gastric air bubble; air-fluid level; and mediastinal widening.

RESULTS:

Among the 35 patients, the esophageal disease was classified as grade I in 9 (25.7%), grade II in 3 (8.6%), grade III in 19 (54.3%), and grade IV in 4 (11.4%). None of the patients with grade I esophageal disease showed changes on chest X-rays. In two of the three patients with grade II disease, there was no gastric air-bubble, although there were no other findings in any of the grade II patients. Of the 19 patients with grade III disease, 15 had abnormal findings on X-rays. All four patients with grade IV disease showed abnormalities.

CONCLUSION:

The use of Rezende's classification is feasible, encompassing findings ranging from the subtle changes that characterize the initial phases of esophageal disease to the complete akinesia seen in dolicomegaesophagus. Chest X-ray findings are more common in patients with advanced stages of the disease and indicate the degree of esophageal involvement in Chagas disease.

KEYWORDS:

Esophageal achalasia/radiography; Esophagus/radiography; Radiography, thoracic

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