Focal spiculation of the upper thoracic esophagus: normal variant at double-contrast esophagography

A review of 100 routine biphasic upper gastrointestinal examinations revealed focal spiculation of the upper thoracic esophagus as a transient finding in 11 patients (11%) who otherwise had no clinical or radiographic signs of esophageal disease. All 11 patients had remarkably similar findings, with thin (1-2 mm wide), transverse folds or striations above the level of the aortic arch, producing a spiculated or serrated appearance in profile. This focal spiculation should be considered a normal variant in the esophagus on double-contrast radiographs. It is suspected that this phenomenon is related to weakening of peristalsis or localized contraction of the longitudinally oriented muscularis mucosae at the junction of the striated- and smooth-muscle portions of the esophagus. Whatever the explanation, radiologists should be familiar with this finding, so that it is not mistaken for a focal area of esophagitis.