EUS – Surgery MCQS

Esophageal Wall Layers EUS MCQ | mcqsurgery.com

Q) A 60-year-old patient undergoes EUS for staging of an early esophageal tumor. Regarding the echogenic layers of the esophageal wall, which of the following statements is INCORRECT?

a) The first hyperechoic layer represents the interface of superficial mucosa with the water-filled lumen b) The second hypoechoic layer corresponds to the deep mucosa c) The fourth hyperechoic layer represents the muscularis propria d) The fifth hyperechoic layer corresponds to the adventitia

Show Answer & Explanation

✅ Answer: c) The fourth hyperechoic layer represents the muscularis propria (incorrect — the fourth layer is hypoechoic and corresponds to muscularis propria).

🔍 Explanation:
EUS shows 5 layers of the esophageal wall:

1. Hyperechoic – superficial mucosa/water interface
2. Hypoechoic – deep mucosa
3. Hyperechoic – submucosa
4. Hypoechoic – muscularis propria
5. Hyperechoic – adventitia

Correct identification is critical for T-staging of esophageal cancer. Misidentifying layer 4 may lead to incorrect staging and management errors. Radial echoendoscopes provide optimal visualization of all layers.

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