The foamy esophagus sign is an appearance seen on a single contrast barium study in Candida esophagitis with associated scleroderma/achalasia (stasis).
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Pathology
The pathophysiologic basis of the foamy esophagus sign is uncertain. Stasis is a predisposing factor. Foam is produced directly by the fungal organisms that colonize the esophagus due to the production of carbon dioxide via oxidative respiration.
Radiographic features
The foamy esophagus appearance is characterized by multiple tiny (1-3 mm), round lucencies that are mixed with the barium suspension along the top of the barium column, producing a layer of foam.
Other fluoroscopic signs of Candida esophagitis include:
multiple plaques
discrete ulcers (mimicking herpes)
cobblestone/snakeskin appearance: when plaques are coalescent
shaggy esophagus: when plaques and pseudomembranes coalesce
benign stricture is also seen in late-stage disease