Today’s radiographs belong to a 53-year-old man with dysphagia.
What do you see?
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Findings: PA radiograph (A) is unremarkable. The lateral view shows a slight anterior bowing of the trachea (B, arrow) with an apparently dilated upper esophagus with an air/solid interface (B, red arrow).
These findings are well seen in the cone down view, which better shows a thickened retrotracheal stripe (C, red arrows), a sign that suggests esophageal pathology, among others.
For all of you who diagnosed achalasia there is a negative finding: the lack of occupation of the retrocardiac space (D, circle) which practically rules out dilatation of the lower esophagus.
Sorry to say that I do not have additional images. After receiving the possible diagnosis of esophageal tumor, the patient went to another hospital, where esophagoscopy and biopsy confirmed upper esophageal dilatation by a carcinoma of the middle third.
Final diagnosis: Carcinoma of the middle third of the esophagus with proximal dilatation and food retention.
Congratulations to Dr Ahmad who was the first to describe the findings.
Teaching point: this case emphasizes the value of clinical information in selected cases. I suspect that some of you would not have discovered the dilated esophagus in the lateral view if I had withheld the history of dysphagia :).
12 thoughts on “Cáceres’ Corner Case 212 – SOLVED”
Distended upper third esophagus
Fluid level in the lateral view behind the trachea mostly within the esophagus …. Achalasia
In the lateral view there is a posterior compression of the upper esophagus! If I think well the patient can have an aberrant subclavian artery, but indeed a CT scan is necessary
Aberrant subclavian is usually asymptomatic and does not cause esophageal dilatation 🙂
….Mi sembra che ci sia uno svasamento del profilo mediastinico alto a dx., con immagine tracheale, in AP , che sembra leggermente deviata medialmente….patologia del mediastino medio, da definire con la TAC….un caro saluto PROF….
Welcome, friend. Was this weekend in Puglia with Lorenzo Bonomo. I believe the main findings are better seen in the lateral view.
Shadow of dilated oesophagus start from diaphragm behind heart up to upper mediastinum
I believe that the retrocardiac space is very well seen. This would go against dilatation of the lower esophagus and achalasia 🙂
distended upper part of oesophagus seen on a lateral view. Barett oesophagus, oesophageal carcinoma.
Dilated upper thoracic esophagus down to rounded tumefaction, with central areas of hyperdensities (ca + vs. Overlapping shadows) suggesting intra luminal mass (leiomyoma, GIST or others).
?? Mediastinal LNs
Decreased bone density.
Calcified foci are seen overlaying hepatic shadow
Dilated upper oesophagus with fluid level seen on the lateral radiograph
On lateral view: posterior mediastinum high density, projected over upper vertebral bodies and middle zone.
Dilated proximal oesophagus.
Posterior mediastinum mass collapsing the oesophagus?