Esofaguskompression

Esofaguskompression, also known as esophageal compression, denotes external pressure on the esophagus by neighboring structures within the mediastinum or neck, leading to impaired passage of food. The condition is not a disease itself but a consequence of another process that narrows or deforms the esophageal lumen.

Common causes include enlargement of adjacent structures or congenital anomalies: left atrial enlargement from mitral valve disease; thoracic aortic aneurysm or arch anomalies; vascular rings (congenital) that encircle and compress the esophagus; goiter or mediastinal thyroid nodules; mediastinal tumors or lymphadenopathy. Degenerative cervical osteophytes and postoperative scar tissue may also contribute.

Clinical presentation centers on dysphagia, typically for solids, with possible retrosternal discomfort, regurgitation, chest pain, or unintended weight loss. Symptoms may vary with head position or swallowing; in children, vascular rings may cause coughing or stridor.

Diagnosis relies on a combination of history, examination, and imaging. A barium esophagogram commonly reveals an external impression on the esophagus. CT or MRI localizes the compressing structure and assesses surrounding anatomy. Endoscopy is used to exclude intrinsic luminal lesions and evaluate mucosal integrity, and esophageal manometry may be employed if motility disorders are suspected.

Management targets the underlying cause. Surgical or medical treatment of the responsible condition—such as repair of an aortic aneurysm, removal of a mediastinal mass, thyroidectomy, or correction of a vascular ring—can relieve compression. In selected cases, temporary endoscopic dilation or stenting may provide symptom relief, and nutritional support is considered when eating is unsafe. Prognosis depends on the etiology and duration of compression; reversible causes have favorable outcomes with appropriate therapy.