Esophageal hemangioma
Introduction
Introduction to esophageal hemangioma Hemengiomaoftheesophagus is a tumor derived from mesenchymal tissue, which is rare in clinical practice and is the lowest incidence of gastrointestinal hemangioma. Esophageal hemangioma has the most upper esophagus, followed by the lower esophagus and the middle esophagus. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: esophageal hemangioma
Cause
Esophageal hemangioma etiology
Cause:
Esophageal hemangioma is due to congenital or acquired vascular occlusion, stenosis and other factors due to congenital or acquired vascular occlusion, stenosis and other factors, resulting in proximal vasodilation to form isolated or scattered blue cystic venous tumor, so there are The name "isolated vein expansion".
Pathogenesis
The disease occurs in the upper part of the esophagus. The size of the tumor varies from a few millimeters to a few centimeters. The vast majority of the tumors appear to grow into the lumen. The tumor is composed of a large number of new capillaries, which can be single or multiple. Polypoid, there may be lobes, the surface may be erosive, occurring in the esophageal mucosa or submucosal layer, up to several centimeters long, also known as mucosal tumor, according to the type of tissue can be roughly divided into capillary hemangioma, cavernous blood vessels Tumors, mixed hemangioma, venous hemangioma, lymphangioma, granulomatous hemangioma and glomus tumors.
Prevention
Esophageal hemangioma prevention
1. A iatrogenic biopsy or endoscopic abrasion can cause hemorrhage of the esophageal hemangioma, or even major bleeding. Therefore, the endoscopic examination of esophageal hemangioma must be gentle. When the endoscope enters the esophageal orifice, it should be followed by a cavity to prevent it. The mechanical damage of the lens to the hemangioma poses a risk of rupture and bleeding.
2. If the hemangioma is suspected, biopsy should not be taken to avoid major bleeding and complicated submucosal infection.
Complication
Esophageal hemangioma complications Complications Esophageal hemangioma
Esophageal hemangioma rupture.
Symptom
Symptoms of esophageal hemangioma Common symptoms : Chest pain when swallowing esophageal bleeding esophageal left wall formation pressure footprint dysphagia
The clinical manifestations of esophageal hemangioma lack specificity, and most patients are asymptomatic, with more than half of the cases found at autopsy.
Because the tumor grows in the esophageal mucosa or submucosa and protrudes into the cavity, symptomatic patients may have different levels of swallowing discomfort, difficulty swallowing, and discomfort after the sternum.
Esophageal hemangioma has the potential to rupture and hemorrhage, but because of its extremely slow growth, spontaneous bleeding rarely occurs. Some patients occasionally swallow sharp foreign bodies (such as chicken bones, fish bones, etc.) to puncture hemangioma and cause massive gastrointestinal bleeding. Some patients can die from major bleeding.
Examine
Examination of esophageal hemangioma
There were no special abnormal changes in the laboratory tests.
1. Esophageal X-ray barium meal examination
X-ray barium meal examination of esophageal hemangioma can be characterized as oval filling defect, clear boundary, smooth edge, internal separation, local esophageal dilatation, similar to other benign esophageal tumors, and its characteristic signs are mucosal folds and flattening Or under pressure, the adjacent mucosa is roughly distorted like varicose veins, but when the lesion is small, it is difficult to distinguish it from small malignant tumor lesions.
Han Yaohua et al (2002) reported that the barium meal examination of esophageal hemangioma showed a X-ray sign similar to the "tumbler" shape. It is speculated that the upper and lower parts of the tumor may protrude prominently into the cavity, while the middle part is slightly protruding into the cavity. Whether this sign has any special significance for the diagnosis of esophageal hemangioma remains to be explored.
2. Esophageal CT examination
CT esophageal plain can be seen in the thickening of the esophageal wall, esophageal stenosis; enhanced scanning lesions are significantly enhanced, the density is higher than the normal esophageal wall, occasionally the introduction of lesions into the blood vessels.
3. Endoscopy
The clinical symptoms and X-ray findings of esophageal hemangioma are lack of specificity. The diagnosis depends mainly on esophagoscopy. Shamji et al. (2002) proposed that endoscopic examination should be the first choice for the diagnosis of esophageal hemangioma, supplemented by non-invasive methods such as enhanced CT. Scan, etc., to avoid traumatic methods such as endoscopic biopsy.
Esophageal hemangioma is characterized by a blue or deep purple-red mass that protrudes into the esophageal cavity under the endoscope and can block the lumen. However, because the esophageal hemangioma is soft, the lens can be smoothly passed after the tumor is gently compressed. The tumor may be lobulated or scorpion-like, or a localized flattened small bulge, mostly light blue, varying in size, and some may be pedicled.
The disease can be multiple, so in the endoscopic examination of the esophagus, in order to improve the detection rate, in the observation of the retrospective, the examiner can not meet the discovery of a single lesion, should be carefully observed while retreating the mirror, especially pay attention to the mucosa at the entrance of the esophagus Changes to avoid omissions.
4. Other inspections
Palchick et al (1983) suggested that some non-invasive methods can be used to identify the diagnosis of esophageal hemangioma, such as enhanced CT scan, radionuclide angiography, etc., can achieve more than invasive methods such as endoscopic biopsy, open chest biopsy More favorable diagnostic basis.
Diagnosis
Diagnosis and diagnosis of esophageal hemangioma
diagnosis
The diagnosis of esophageal hemangioma relies on esophageal sputum angiography and esophagoscopy. When performing X-ray and endoscopy, the patient can enlarge the abdominal cavity or deep inspiratory, which is consistent with the characteristics of hemangioma.
Differential diagnosis
Portal hypertension
When the esophageal lesion is more than 2cm in diameter, if the patient is accompanied by cirrhosis, it may indicate the possibility of esophageal varices caused by portal hypertension. It should be further examined and identified. If it is clearly diagnosed as portal hypertension, it has been treated with sclerotherapy. , should be differentiated from residual veins or re-variable veins after varicose sclerotherapy.
2. Blue rubber-bleb nevus syndrome
Blue rubbery herpes-like hernia syndrome is an autosomal dominant hereditary disease, first reported by Bean (1958), so it is also called Beans syndrome. This syndrome is a familial epidermal hemangioma. It is a heterotypic disease of hemangiomas. The pathological nature is cavernous hemangioma, and some have no family history. It is characterized by blue-blue hemangioma in the skin. Skin lesions occur mostly in childhood, often at birth, or in infants and young children. The main site of the disease is in the limbs, the trunk skin, and can also grow in the mouth, the tongue and throat mucosa. If this syndrome is complicated by gastrointestinal hemangioma, it can be manifested as gastrointestinal bleeding, repeated melena and anemia.
3. Patients with small lesions should be differentiated from esophageal retention cysts. Patients with spontaneous bleeding should be differentiated from hemorrhagic degeneration of leiomyomas.
