The Pleural Esophageal Reflection: an Aid in the Evaluation of Esophageal Disease

The radiographic diagnosis of esophageal disease depends primarily upon the configuration of contrast material in the esophageal lumen. It has been pointed out (3) that large bulky tumors producing a considerable extraluminal mass can be visualized on the roentgenogram. It is less commonly recognized that minor variations in esophageal wall thickness can also be identified radiographically. Gladnikoff (2), in his classic monograph on the mediastinum, and more recently Cimmino (1), in an article entitled “Further Notes on the Esophageal Pleural Stripe,” have demonstrated the relationship of the esophagus to the medial margin of the lung. Little emphasis has been placed on utilizing this relationship as a means of evaluating changes in esophageal wall thickness, though Johnstone (4) did illustrate on radiographs esophageal thickening in diffuse spasm and diffuse muscle hypertrophy of the lower esophagus. Figure 1 is a diagram of the relationship of the lung margin to the esophagus and other bordering medias...