Shaggy esophagus | Radiology Signs

Answer:

Shaggy esophagus is caused by severe Candida esophagitis, an opportunistic fungal infection of the esophageal mucosa most commonly due to Candida albicans, typically seen in immunocompromised patients such as those with HIV/AIDS, diabetes, or on immunosuppressive therapy. It manifests radiologically as a grossly irregular, shaggy contour of the esophageal lumen due to innumerable coalescent pseudomembranes, raised plaques, and ulcers.

Why is it called so?

It is called “shaggy esophagus” because the barium-coated esophageal mucosa appears irregular and frayed, resembling a shaggy or unkempt surface, due to the presence of numerous plaques, pseudomembranes, and ulcerations projecting into the lumen.

Pathophysiology

Candida organisms colonize and invade the esophageal epithelium, leading to formation of raised mucosal plaques composed of necrotic epithelial debris, inflammatory cells, and fungal hyphae. These plaques and associated ulcers create multiple filling defects and irregular mucosal contours on barium esophagography. In severe or fulminant cases, the plaques coalesce and are interspersed with ulcers, resulting in a markedly irregular, “shaggy” appearance of the esophageal wall with barium trapped between lesions.

Alternative names: Shaggy esophagus is also referred to as the “shaggy” appearance of Candida esophagitis.

Other associated named signs: Other associated signs in Candida esophagitis include the “cobblestone” or “snakeskin” appearance on double-contrast esophagography and pseudodiverticula (narrow, flask-shaped dilations of excretory ducts).