The thoracic esophagus: sectional anatomy and radiosurgical applications

Abstract

The relationships of a tumor of the thoracic esophagus to the adjacent mediastinal structures are currently studied by means of computed tomography (CT), magnetic resonance imaging (MRI) and, more recently, by echoendoscopy. However, the assessment of axial mediastinal CT and of MRI in the coronal and sagittal planes calls for some degree of experience. To further this training a sectional anatomy is proposed in correlation with imaging of the thoracic esophagus and the posterior mediastinum. Ten fresh subjects whose vascular networks had been previously injected with colored resin were sectioned along the three planes of space after positioning under CT monitoring. The axial sections were compared with the CT images made with a GE 9800 Quick scanner. Three frontal and sagittal sections were compared with the MRI images made with a GE Signa apparatus using a high magnetic field. The relations of the esophagus were studied at three levels: the supra-azygo-aortic segment, where it is related to the left subclavian artery; the inter-azygo-aortic segment, where access to the esophagus is barred on the left by the aortic arch and on the right by the arch of the azygos vein, section of which provides ample access; and the sub-azygo-aortic segment, where the esophagus passes behind the left main bronchus and to the right of the descending aorta, two organs whose invasion contraindicates excision of a tumor of the esophagus but is difficult to assess by current thoracic imaging techniques. The esophagus then descends behind the left atrium; the investigation of the kinetics of the heart cavities by transesophageal echocardiography is an application of this anatomic relationship.(ABSTRACT TRUNCATED AT 250 WORDS)

Plasma Level of Transforming Growth Factor β1 Measured from the Azygos Vein Predicts Prognosis in Patients with Esophageal Cancer

“…obtained from the azygos vein instead of a peripheral vein was measured and correlated with pathological findings and survival of patients with esophageal cancer. The azygos vein is chiefly responsible for venous return from the esophagus, and the level of plasma TGF-␤1 in the azygos vein may therefore reflect tumor progression and condition more directly and accurately than the TGF-␤1 level in other veins (20). Plasma for normal controls could not be obtained from the azygos vein of healthy volunteers, so we used the mean value measured from peripheral veins, as described previously (13).…”

Left Atrial‐Esophageal Fistula Complicating Radiofrequency Catheter Ablation of Atrial Fibrillation

“…The esophagus is located at the center of the posterior mediastinum and is separated from the left atrium only by the pericardial sac (oblique sinus), which insinuates itself between the openings of the right and left PVs 13 . The left atrial posterior wall thickness is 2–4 mm 14 and the esophagus thickness is 2–3 mm in a cross section on the left atrial‐esophageal area of contact 15 .…”

“…Thus, reports of atrium-esophageal fistula could increase following extensive ablation of left atrial posterior wall.The esophagus is located at the center of the posterior mediastinum and is separated from the left atrium only by the pericardial sac (oblique sinus), which insinuates itself between the openings of the right and left PVs. 13 The left atrial posterior wall thickness is 2-4 mm 14 and the esophagus thickness is 2-3 mm in a cross section on the left atrialesophageal area of contact. 15 During RF catheter ablation, lesion depth, extension and volume are related to the design of ablation electrode and RF power delivered.…”

Angiogenic factors: role in esophageal cancer, a brief review

“…In tumors, it acts early in carcinogenesis as a tumor suppressor but acts later as a stimulator of tumor invasion by prompting extracellular matrix production and angiogenesis, stimulating tumor proliferation, and inhibiting host immune functions. Loss or resistance of this inhibitory effect to TGF-β has been reported in many tumor cells and elevated systemic TGF-β1 levels have been reported in various cancers [40][41][42][43][44][45], as well as increased local TGF-β1 has been observed in many cancer cells [47]. Local expression of TGF-β1 was related to tumor progression in esophageal cancer, in contrast to systemic TGF-β1 level [43].…”

“…In a study, plasma TGF-β1 level was obtained from venous blood of the azygos vein instead of a peripheral vein and was measured and correlated with pathological findings and survival of patients with esophageal cancer. The azygos vein is responsible for venous return from the esophagus, and his level of plasma TGF-β1 may reflect tumor progression and condition more directly and accurately than the TGF-β1 level in other veins [47]. Plasma for normal controls could not be obtained from the azygos vein of healthy volunteers, so it was used the mean value measured from peripheral veins [43].…”