Candida Esophagitis: Feathery Appearance as a New Sign on Barium Esophagogram

The characteristic appearance of Candida esophagitis on barium studies is that of diffuse discrete mucosal plaques, which may become confluent to form 'cobblestone or shaggy' esophagus. Many authors have also reported different radiographic findings such as a foamy appearance in florid esophageal candidiasis in immunocompromised patients. This report discusses a “feathery” appearance seen in barium esophagography of a 74‑year‑old woman who presented with dysphagia. The barium swallow showed fine out‑ pouching giving a “feathery” appearance, which is similar to what is described as pseudo‑diverticulosis in patients with esophagitis complicating gastro‑esophageal reflux disease. A diagnosis of esophagitis presumably due to candidiasis was made. This was confirmed by fungal studies on biopsy specimen following flexible esophagoscopy. Radiologists should be aware of this rare manifestation as a new sign of Candida esophagitis in order to avoid unnecessary delay in diagnosis and treatment.