吞咽超声造影检出钡餐食管造影漏诊的微小颈部食管憩室：一例病例报告

文献信息

中文摘要

背景： 钡餐食管造影是食管病变的标准检查方法，但可能漏诊细微的小憩室。既往文献曾报道吞咽超声造影（SCEUS）用于食管憩室检测。本例报告一例被误分类为C-TIRADS 4A甲状腺结节的微小颈部食管憩室，钡餐食管造影未检出，但经SCEUS显示。我们描述该易误诊病变的影像学特征及微泡造影的增量价值。
病例介绍： 我们报告一例38岁中国男性，初始无食管相关临床症状。2019年6月，常规超声检查发现左甲状腺叶中上极后内侧有一实性结节，大小约5.1 × 3.5 mm。该结节与邻近食管壁解剖关系密切，提示可能来源于食管。随后行钡餐食管造影，未见明显异常。鉴于无相关临床症状，患者被纳入年度随访方案。2025年1月18日，常规灰阶超声显示病灶最大径较初次检查增加1 mm，遂进一步行SCEUS评估，明确证实左甲状腺叶中上三分之一处存在食管憩室，大小为5.6 × 3.8 mm。为便于直观视觉比较，纳入一名健康志愿者以获取显示正常生理吞咽形态的标准SCEUS图像。
结论： 在本单例中，SCEUS显示了钡餐食管造影未检出的微小颈部食管憩室，有助于避免不必要的甲状腺切除术。微泡造影可动态实时显示憩室与食管的交通，而单纯饮水吞咽超声无法完全分辨。然而，这一单次观察不能支持SCEUS具有普遍更优的诊断效能。需要进一步队列研究以验证SCEUS对模拟甲状腺结节的小食管憩室的临床效用。

英文摘要

BACKGROUND: Barium esophagography is standard for esophageal lesions but may miss subtle small diverticula. Prior literatures have reported swallow contrast-enhanced ultrasonography (SCEUS) for esophageal diverticulum detection. This case presents a tiny cervical esophageal diverticulum misclassified as C-TIRADS 4A thyroid nodule, undetected by barium esophagography but visualized by SCEUS. We describe the imaging characteristics and incremental value of microbubble contrast for this easily misdiagnosed entity.
CASE PRESENTATION: We report the case of a 38-year-old Chinese man with no initial clinical symptoms related to the esophagus. In June 2019, a routine ultrasonographic examination revealed a solid nodule easuring approximately 5. 1 × 3.5 mm in the posteromedial aspect of the middle and upper pole of the left thyroid lobe. This nodule demonstrated close anatomical proximity to theadjacent esophageal wall, raising suspicion for an esophageal origin. Subsequent barium esophagography was performed, which demonstrated no significant abnormalities. Given the absence of related clinical symptoms, the patient was placed on an annual follow-up protocol. On January 18, 2025, conventional gray-scale ultrasonography revealed a 1-mm increase in the maximum diameter of the lesion compared with the initial examination, prompting further evaluation with SCEUS, which clearly confirmed the presence of an esophageal diverticulum in the upper-middle third of the left thyroid lobe measuring 5.6 × 3.8 mm in size. For intuitive visual comparison, one healthy volunteer was enrolled to acquire standard SCEUS images depicting normal physiological swallowing morphology.
CONCLUSION: In this single case, SCEUS visualized a tiny cervical esophageal diverticulum undetected by barium esophagography, helping avoid unnecessary thyroid resection. Microbubble contrast provides dynamic real-time delineation of diverticular communication that cannot be fully resolved by plain water swallow ultrasound. However, this single observation cannot support generalized superior diagnostic performance of SCEUS. Further cohort studies are needed to validate the clinical utility of SCEUS for small esophageal diverticula mimicking thyroid nodules.