Levine M S, Loevner L A, Saul S H, Rubesin S E, Herlinger H, Laufer I
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104.
AJR Am J Roentgenol. 1988 Jul;151(1):57-62. doi: 10.2214/ajr.151.1.57.
During a 10-year period between 1978 and 1987, there were 25 confirmed cases of herpes esophagitis with positive esophageal brushings, biopsies, and/or cultures for the herpes simplex virus. Eighteen of those patients had double-contrast esophagrams, but two were excluded from our study because they had combined fungal and viral esophagitis. All of the remaining 16 patients were symptomatic, and 14 were immunocompromised. Herpes esophagitis was diagnosed on the original radiographic reports in nine (56%) of those 16 patients. In all nine, double-contrast radiographs revealed discrete, superficial ulcers on a relatively normal background mucosa without significant plaque formation. In the remaining seven patients, double-contrast esophagrams revealed plaquelike lesions that were indistinguishable from those of Candida esophagitis (four cases), thickened folds (two cases), and a giant esophageal ulcer (one case). During the same period, herpes esophagitis was diagnosed on seven other double-contrast esophagrams in which histologic, cytologic, and virologic studies were negative for the herpes simplex virus. However, the endoscopic findings were also suspicious for herpes esophagitis in six of those cases, suggesting that they may represent true-positive cases in which there was inadequate tissue sampling. Thus, our experience indicates that radiographic abnormalities can almost always be detected on double-contrast esophagrams in patients with herpes esophagitis, and in more than 50% of cases, a specific radiographic diagnosis can be made because of discrete ulcers without significant plaque formation.
在1978年至1987年的10年期间，有25例经确诊的疱疹性食管炎病例，其食管刷检、活检和/或单纯疱疹病毒培养结果呈阳性。其中18例患者进行了双重对比食管造影，但有2例因合并真菌和病毒性食管炎而被排除在我们的研究之外。其余16例患者均有症状，其中14例免疫功能低下。在这16例患者中，有9例（56%）在最初的影像学报告中被诊断为疱疹性食管炎。在所有9例中，双重对比X线片显示在相对正常的背景黏膜上有离散的浅表溃疡，无明显斑块形成。在其余7例患者中，双重对比食管造影显示出与念珠菌性食管炎难以区分的斑块样病变（4例）、增厚的皱襞（2例）和巨大食管溃疡（1例）。在同一时期，在另外7例双重对比食管造影中诊断出疱疹性食管炎，而这些病例的组织学、细胞学和病毒学研究结果显示单纯疱疹病毒为阴性。然而，其中6例的内镜检查结果也怀疑为疱疹性食管炎，这表明它们可能代表了组织取样不足的真阳性病例。因此，我们的经验表明，疱疹性食管炎患者在双重对比食管造影上几乎总能检测到影像学异常，并且在超过50%的病例中，由于存在离散溃疡且无明显斑块形成，可以做出特定的影像学诊断。
