PAEA Surgery End Of Rotation (EOR) Practice Exam

Which condition is characterized by a "corkscrew" appearance in imaging?

1. Achalasia

2. Hiatal hernia

3. Esophageal spasm

4. Nutcracker esophagus

The correct answer is: Esophageal spasm

The condition recognized for its characteristic "corkscrew" appearance on imaging, particularly fluoroscopy, is esophageal spasm. This phenomenon is a result of intermittent contractions of the esophageal muscles, which can create a pattern resembling a corkscrew. The spasm can lead to symptoms such as chest pain and difficulty swallowing, as the esophagus undergoes uneven, chaotic muscle contractions leading to the distinctive radiographic finding. In this context, achalasia does involve issues with esophageal motility and can cause structural changes in the esophagus, typically leading to a dilated esophagus with a narrowed lower esophageal sphincter, but it does not exhibit the "corkscrew" appearance. A hiatal hernia primarily reflects anatomical displacement and would manifest differently on imaging, often showing protrusion of stomach tissue into the thoracic cavity rather than the spasm-related appearance. Nutcracker esophagus is similar in its muscular contractions but tends to demonstrate a more coordinated contraction pattern rather than the disordered, spiral-like configurations of esophageal spasm. Thus, the hallmark "corkscrew" appearance is specifically associated with esophageal spasm, confirming that this condition is distinguished by its unique imaging characteristics.