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Chapter 25: The Esophagus and Diaphragmatic Hernia

Locations of anatomic narrowing of the esophagus seen on an esophagram include all of the following EXCEPT

A. Lower esophageal sphincter

B. Crossing of the left mainstem bronchus and aortic arch

C. Thoracic outlet

D. Cricopharyngeal muscle

Answer: C

Three normal areas of esophageal narrowing are evident on the barium esophagogram or during esophagoscopy. The uppermost narrowing is located at the entrance into the esophagus and is caused by the cricopharyngeal muscle. Its luminal diameter is 1.5 cm, and it is the narrowest point of the esophagus. The middle narrowing is due to an indentation of the anterior and left lateral esophageal wall caused by the crossing of the left main stem bronchus and aortic arch. The luminal diameter at this point is 1.6 cm. The lowermost narrowing is at the hiatus of the diaphragm and is caused by the gastroesophageal sphincter mechanism. The luminal diameter at this point varies somewhat, depending on the distention of the esophagus by the passage of food, but has been measured at 1.6 to 1.9 cm. These normal constrictions tend to hold up swallowed foreign objects, and the overlying mucosa is subject to injury by swallowed corrosive liquids because of their slow passage through these areas. (See Schwartz 10th ed., p. 942.)

The cervical esophagus receives its blood supply primarily from the

A. Internal carotid artery

B. Inferior thyroid artery

C. Superior thyroid artery

D. Inferior cervical artery

E. Facial artery

Answer: B

The cervical portion of the esophagus receives its main blood supply from the inferior thyroid artery. The thoracic ­portion receives its blood supply from the bronchial arteries, with 75% of individuals having one right-sided and two left-sided branches. Two esophageal branches arise directly from the aorta. The abdominal portion of the esophagus receives its blood supply from the ascending branch of the left gastric artery and from inferior phrenic arteries. On entering the wall of the esophagus, the arteries assume a T-shaped division to form a longitudinal plexus, giving rise to an intramural vascular network in the muscular and submucosal layers. As a consequence, the esophagus can be mobilized from the stomach to the level of the aortic arch without fear of devascularization and ischemic necrosis. Caution should be exercised as to the extent of esophageal mobilization in patients who have had a previous thyroidectomy with ligation of the inferior thyroid arteries proximal to the origin ...

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