Endosonographic features of esophageal tuberculosis presenting as a subepithelial lesion

Esophageal tuberculosis is rare, even in countries with high prevalence of tuberculosis. It usually presents as an ulcerative lesion on conventional endoscopy. Due to its rarity, when esophageal tuberculosis presents as a subepithelial lesion (SEL), conventional endoscopy and other imaging modalities such as computed tomography (CT) are often insufficient to distinguish it from other diseases. From January 2007 to December 2014, 1094 patients who underwent endoscopic ultrasonography (EUS) were retrospectively analyzed. A total of six SELs were diagnosed as tuberculosis. Five lesions were located in the mid-esophagus, and one lesion was located in the lower esophagus. Four lesions were located in the submucosal and muscularis propria layers, and two were located in the deep mucosal and submucosal layers. All lesions exhibited a mural growth pattern, heterogeneously hypoechoic echogenicity and distinct borders. Hyperechogenic spots were observed in four lesions, and conglutination of the lesion to the adjacent lymph node was observed in two lesions. This case series shows that esophageal tuberculosis should be included in mind in the differential diagnosis of esophageal SELs and EUS can be helpful to increase diagnosis rate of esophageal tuberculosis. Copyright © 2017 John Wiley & Sons, Ltd.