RESUMO
Primary tumors of the heart are rare with fibromas most commonly identified in utero or infancy and rarely developing in adulthood. Patients with cardiac fibromas are often asymptomatic until tumor enlargement results in obstructive and nonspecific symptoms. A 39-year-old female presented with 5-year history of recurrent chest pain with functional dysphagia, indicative of esophageal spasm. Imaging identified a large left ventricular (LV) fibroma compressing the esophagus provoking esophageal spasm. The fibroma was excised measuring 51 × 39 mm. This case describes presentation with esophageal spasm, contributing a novel presentation of LV fibroma to the literature.
Assuntos
Espasmo Esofágico Difuso , Fibroma , Neoplasias Cardíacas , Adulto , Espasmo Esofágico Difuso/patologia , Feminino , Fibroma/diagnóstico , Fibroma/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Ventrículos do Coração/cirurgia , HumanosAssuntos
Espasmo Esofágico Difuso/patologia , Esôfago/patologia , Idoso de 80 Anos ou mais , Dor no Peito/etiologia , Transtornos de Deglutição/etiologia , Dilatação , Espasmo Esofágico Difuso/complicações , Estenose Esofágica/complicações , Estenose Esofágica/patologia , Estenose Esofágica/terapia , Esofagoscopia , Refluxo Gastroesofágico/etiologia , Humanos , Masculino , Redução de PesoAssuntos
Transtornos de Deglutição/diagnóstico por imagem , Espasmo Esofágico Difuso/diagnóstico por imagem , Esofagoscopia , Esôfago/patologia , Vômito/diagnóstico por imagem , Adulto , Sulfato de Bário , Meios de Contraste , Transtornos de Deglutição/patologia , Espasmo Esofágico Difuso/patologia , Humanos , Masculino , Radiografia , Remissão Espontânea , Vômito/etiologiaRESUMO
BACKGROUND: Limited data exist on the use of peroral endoscopic myotomy (POEM) for therapy of spastic esophageal disorders (SEDs). OBJECTIVE: To study the efficacy and safety of POEM for the treatment of patients with diffuse esophageal spasm, jackhammer esophagus, or type III (spastic) achalasia. DESIGN: Retrospective study. SETTING: International, multicenter, academic institutions. PATIENTS: All patients who underwent POEM for treatment of SEDs refractory to medical therapy at 11 centers were included. INTERVENTIONS: POEM. MAIN OUTCOME MEASUREMENTS: Eckardt score and adverse events. RESULTS: A total of 73 patients underwent POEM for treatment of SEDs (diffuse esophageal spasm 9, jackhammer esophagus 10, spastic achalasia 54). POEM was successfully completed in all patients, with a mean procedural time of 118 minutes. The mean length of the submucosal tunnel was 19 cm, and the mean myotomy length was 16 cm. A total of 8 adverse events (11%) occurred, with 5 rated as mild, 3 moderate, and 0 severe. The mean length of hospital stay was 3.4 days. There was a significant decrease in Eckardt scores after POEM (6.71 vs 1.13; P = .0001). Overall, clinical response was observed in 93% of patients during a mean follow-up of 234 days. Chest pain significantly improved in 87% of patients who reported chest pain before POEM. Repeat manometry after POEM was available in 44 patients and showed resolution of initial manometric abnormalities in all cases. LIMITATIONS: Retrospective design and selection bias. CONCLUSION: POEM offers a logical therapeutic modality for patients with SEDs refractory to medical therapy. Results from this international study suggest POEM as an effective and safe platform for these patients.
Assuntos
Acalasia Esofágica/cirurgia , Espasmo Esofágico Difuso/cirurgia , Cirurgia Endoscópica por Orifício Natural/métodos , Adulto , Idoso , Dor no Peito/etiologia , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/patologia , Espasmo Esofágico Difuso/diagnóstico , Espasmo Esofágico Difuso/patologia , Esofagoscopia , Esôfago , Feminino , Humanos , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Estudos RetrospectivosAssuntos
Endoscopia/métodos , Espasmo Esofágico Difuso/patologia , Espasmo Esofágico Difuso/cirurgia , Esôfago/patologia , Distrofia Muscular do Cíngulo dos Membros/diagnóstico , Distrofia Muscular do Cíngulo dos Membros/patologia , Adulto , Esôfago/diagnóstico por imagem , Histocitoquímica , Humanos , Masculino , Manometria , Radiografia , UltrassonografiaAssuntos
Espasmo Esofágico Difuso , Esôfago , Animais , Espasmo Esofágico Difuso/diagnóstico , Espasmo Esofágico Difuso/metabolismo , Espasmo Esofágico Difuso/patologia , Espasmo Esofágico Difuso/fisiopatologia , Espasmo Esofágico Difuso/terapia , Esôfago/metabolismo , Esôfago/patologia , Esôfago/fisiopatologia , HumanosAssuntos
Humanos , Esôfago/fisiopatologia , Transtornos da Motilidade Esofágica/etiologia , Transtornos da Motilidade Esofágica/fisiopatologia , Acalasia Esofágica/fisiopatologia , Acalasia Esofágica/genética , Acalasia Esofágica/parasitologia , América Latina , Dor no Peito/etiologia , Dor no Peito/fisiopatologia , Doença de Chagas/complicações , Espasmo Esofágico Difuso/complicações , Espasmo Esofágico Difuso/patologiaRESUMO
We previously showed, in normal subjects, a positive correlation between the esophageal contraction amplitude and peak muscle thickness. The goal of this study was to determine the relationship between esophageal muscle thickness and contraction amplitude in patients with high-amplitude peristaltic and simultaneous contractions. Eleven patients with high-amplitude peristaltic contractions, 8 with diffuse esophageal spasm (DES), 7 with nonspecific (NS) motor disorder of the esophagus, and 10 normal subjects were studied using simultaneous pressure and ultrasound imaging. Pressure was recorded by manometry and ultrasound imaging with a high-frequency ultrasound probe catheter. Recordings were performed in the lower esophageal sphincter (LES) and at 2, 4, 6, 8, and 10 cm above the LES during resting state and swallow-induced contractions. Baseline esophageal muscle was thicker in the distal, compared with the proximal esophagus both in normal subjects and patient groups. Patients with DES and nutcracker esophagus (NC) have a higher baseline muscle thickness compared with normal and NS patients. Correlation between the peak pressure and the peak muscle thickness was weaker in patients with NC and DES compared with normal subjects and patients with NS. Whereas normal subjects have good correlation between delta (difference between peak and baseline) muscle thickness and peak pressures, this relationship was absent in patients with NC and DES. Increase in contraction amplitude in patients with NC and DES was associated with an increase in baseline thickness of esophageal muscularis propria. Increase in baseline thickness was specific to patients with spastic motor disorders and was not seen in patients with NS.
Assuntos
Espasmo Esofágico Difuso/patologia , Espasmo Esofágico Difuso/fisiopatologia , Esôfago/patologia , Esôfago/fisiopatologia , Adulto , Idoso , Deglutição , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/patologia , Transtornos de Deglutição/fisiopatologia , Espasmo Esofágico Difuso/diagnóstico por imagem , Esôfago/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contração Muscular , Músculo Liso/diagnóstico por imagem , Músculo Liso/patologia , Músculo Liso/fisiopatologia , Pressão , UltrassonografiaRESUMO
Since the pharynx and the esophagus are a functional unit, functional radiodiagnosis has to be directed at pharyngo-esophageal interaction. Among our collective of 73 patients suffering from achalasia or diffuse esophageal spasm, we were able to recognize a substantially increased incidence of morphological or functional pharyngeal disorders by means of cineradiography. The functional alterations in particular were often not revealed by conventional fluoroscopy. High-speed cineradiography, with its high temporal and spatial resolution, turned out to be a valuable tool in analysis of the origin of pharyngeal dysphagia. Manometry correlated very well with the radiologic findings in tubular esophagus, but proved unreliable in the detection of alterations of the upper esophageal sphincter region, because of problems inherent in the method. Furthermore, membranous stenosis (webs), lateral or dorsal diverticula, and asymmetry of the pharynx were observed strikingly often.