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Cytomegalovirus esophagitis in AIDS: radiographic features in 16 patients
E J Balthazar1, A J Megibow, D Hulnick
1Department of Radiology, New York University Medical Center/Bellevue Hospital, NY 10016.
Abstract:
Cytomegalovirus is one of the more common opportunistic organisms implicated in the development of esophagitis in patients with AIDS. A review of the radiographic features of 16 proved cases of cytomegalovirus esophagitis showed a spectrum of abnormalities related to the severity of the inflammatory process. Seven patients had a mild form of esophagitis with segmental involvement characterized by granular mucosa, superficial erosions, and poorly defined, shallow ulcerations. Nine patients had more severe esophagitis with solitary or multiple deep ulcers and a background of normal mucosa. The deep ulcerations were oval in shape and varied in size. Some projected intraluminally and had a thin rim of radiolucency at the base. Short-term follow-up examinations showed progression of the disease in four patients, no change in one patient, and regression without specific therapy in one patient. Although these radiographic features are highly suggestive of cytomegalovirus esophagitis, the diagnosis requires histologic confirmation.
Insights
Cytomegalovirus (CMV) esophagitis in AIDS patients presents varied radiographic findings. These include granular mucosa, shallow erosions, and deep ulcerations, aiding diagnosis but requiring histologic confirmation.
Area of Science:
- Medical Imaging
- Infectious Diseases
- Gastroenterology
Background:
- Cytomegalovirus (CMV) is a frequent opportunistic pathogen in individuals with Acquired Immunodeficiency Syndrome (AIDS).
- Esophagitis, an inflammation of the esophagus, can be caused by CMV in immunocompromised patients.
- Radiographic imaging plays a role in visualizing esophageal abnormalities.
Purpose of the Study:
- To review and characterize the radiographic features of cytomegalovirus esophagitis in patients with AIDS.
- To correlate imaging findings with disease severity.
- To assess the diagnostic utility of radiography in suspected CMV esophagitis.
Main Methods:
- Retrospective review of radiographic examinations from 16 confirmed cases of CMV esophagitis.
- Analysis of imaging findings, including mucosal abnormalities, erosions, and ulcerations.
- Correlation of radiographic features with clinical presentation and disease severity.
Main Results:
- A spectrum of abnormalities was observed, related to inflammatory process severity.
- Mild esophagitis showed segmental involvement with granular mucosa, superficial erosions, and shallow ulcerations.
- Severe esophagitis presented with solitary or multiple deep, oval ulcerations, some with radiolucent rims.
- Follow-up showed disease progression in some, stability in one, and regression in another.
Conclusions:
- Radiographic features of CMV esophagitis are suggestive but not definitive.
- Imaging findings range from superficial changes to deep ulcerations.
- Histologic confirmation remains essential for a definitive diagnosis of CMV esophagitis.