Pathophysiologic basis of the foamy esophagus 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.
The foamy esophagus 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
- intramural pseudodiverticulosis
- double barrel esophagus
- benign stricture is also seen in late-stage disease
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- 2. Levine MS, Rubesin SE, Herlinger H et-al. Double-contrast upper gastrointestinal examination: technique and interpretation. Radiology. 1988;168 (3): 593-602. Radiology (citation) - Pubmed citation