Identifying non-malignant oesophageal diseases

It is important to recognise non-malignant oesophageal diseases; however, they can easily go unnoticed or be misdiagnosed radiologically. With this paper, the authors aim to cover the important clinical features and imaging findings of non-malignant pathology of the oesophagus.

Teaching points:

  • Non-malignant oesophageal disease can be categorised by the imaging appearance of wall and lumen
  • Scleroderma and achalasia both cause lumen dilatation via different pathophysiologic pathways.
  • Oesophageal wall thickening can be inflammatory, neoplastic, traumatic, or vascular in aetiology.


Non-malignant oesophageal diseases are critical to recognize, but can be easily overlooked or misdiagnosed radiologically. In this paper, we cover the salient clinical features and imaging findings of non-malignant pathology of the oesophagus. We organize the many non-malignant diseases of the oesophagus into two major categories: luminal disorders and wall disorders. Luminal disorders include dilatation/narrowing (e.g. achalasia, scleroderma, and stricture) and foreign body impaction. Wall disorders include wall thickening (e.g. oesophagitis, benign neoplasms, oesophageal varices, and intramural hematoma), wall thinning/outpouching (e.g. epiphrenic diverticulum, Zenker diverticulum, and Killian-Jamieson diverticulum), wall rupture (e.g. iatrogenic perforation, Boerhaave Syndrome, and Mallory-Weiss Syndrome), and fistula formation (e.g. pericardioesophageal fistula, tracheoesophageal fistula, and aortoesophageal fistula). It is the role of the radiologist to recognize the classic imaging patterns of these non-malignant oesophageal diseases to facilitate the delivery of appropriate and prompt medical treatment.


Marini T, Desai A, Kaproth-Joslin K et al. (2017) Imaging of the oesophagus: beyond cancer. Insights Imaging 8(3):365-376. doi:10.1007/s13244-017-0548-3