What causes Reverse 3 sign in esophagus on barium swallow?
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Answer:
Reverse 3 sign (also known as E sign or epsilon sign) represents indentation of the esophagus due to post-stenotic dilatation of the aorta in coarctation of the aorta, a congenital narrowing typically at the aortic isthmus near the ligamentum arteriosum.
Why is it called so?
Named for its “epsilon“-like (ฮต) or reverse figure-3 shape formed by the post-stenotic aortic dilatation impressing on the esophagus, complementing the classic figure-3 sign of pre- and post-stenotic dilatation on chest X-ray.
Pathophysiology
Coarctation of the aorta causes proximal aortic hypertension leading to pre-stenotic dilatation and distal hypotension with post-stenotic dilatation; the pulsatile post-stenotic aneurysmal dilatation abuts and indents the posterior esophagus, creating the characteristic curvilinear impression on barium swallow.
Alternative names: E sign, epsilon sign
Other associated named signs: Figure-3 sign
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