Esophageal Leiomyoma

Leiomyomas of the esophagus are relatively rare, but are by far the most frequent benign tumor of the esophagus. 6o% occur in the lower third of the esophagus, 33% in the middle third and 7% in the upper third, reflecting the smaller amount of smooth muscle in the upper esophagus.

Contrast swallow studies reveal a characteristic appearance:

• No obstruction to flow of barium
• Normal motility
• Mass moves with the esophagus on swallowing
• Sharp margin between the mass and uninvolved esophagus
• Smooth, rounded or crescent-shaped filling defect in profile
• Abrupt "step" or "shelf" in the lumen with on the lateral view.
• A smooth or lobulated companion soft tissue mass may be seen opposite the filling defect
• There may be stretching or flattening of overlying mucosal folds by larger masses.
• Barium column may be split to either side of the mass, producing a "forked-stream" appearance when viewed en face.
• Esophagus may also appear narrowed near the mass when viewed en face
• Calcification may be seen, but is unusual

References

Godard JE, McCranie D. Multiple leiomyomas of the esophagus. Am J Roentgenol Radium Ther Nucl Med. 1973 Feb;117(2):259-62.