식도 결핵, 호발 위치, Esophageal tuberculosis, middle third of the esophagus at the carina level

The global burden of tuberculosis remains enormous, mainly because of poor control and coexisting nature of M. tuberculosis and HIV. Tuberculosis has been known to involve the esophagus, either as a primary infection or as a secondary manifestation of reactivated disease. The exposure of the esophagus to the organism is limited by the rapid clearance of infected sputum by means of coordinated peristalsis, combined with upright posture and an intact lower esophageal sphincter [1]. Esophageal tuberculosis is almost always associated with mediastinal lymphadenopathy with or without a tracheo-esophageal fistula [2]. The two most common differential diagnoses are carcinomaof the esophagus and Crohn’s disease of the esophagus [3,4]. Tuberculosis of the esophagus is a rare condition, even in countries with a high incidence of tuberculosis (TB) [5,6], and studies estimate that it constitutes about 0.3% of gastrointestinal TB cases [7]. Involvement of the gastrointestinal tract occurs through ingestion of infected sputum or hematogenous spread from primary pulmonary TB [8]. Most cases of esophageal tuberculosis are secondary to direct extension from adjacent structures, such as mediastinal lymph nodes or pulmonary sites. Primary esophageal tuberculosis is even rarer [9]. Esophagic involvement by tuberculosis usually affects the middle third of the esophagus at the carina level [10].

식도 결핵은 드뭅니다. 

만일 발생한다면 거의 항상 mediastinal lymphadenopathy와 관련되어 있습니다. 대부분은 인접 구조물(mediastinal lymph nodes 또는 pulmonary sites)에서 2차적으로 인접하여 발생하고 1차적으로 발생하는 경우는 더욱 드뭅니다. 

따라서 결핵에 의한 식도 관련은 보통 carina 위치인 식도의 2/3 지점입니다.