Cáceres’ Corner Case 212 – SOLVED

Dear Friends,

Today’s radiographs belong to a 53-year-old man with dysphagia. 

What do you see? 
Come back on Friday to see the answer!

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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

  1. Good morning!!

    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

    1. Aberrant subclavian is usually asymptomatic and does not cause esophageal dilatation 🙂

  2. ….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….

    1. Welcome, friend. Was this weekend in Puglia with Lorenzo Bonomo. I believe the main findings are better seen in the lateral view.

  3. Shadow of dilated oesophagus start from diaphragm behind heart up to upper mediastinum

  4. I believe that the retrocardiac space is very well seen. This would go against dilatation of the lower esophagus and achalasia 🙂

  5. distended upper part of oesophagus seen on a lateral view. Barett oesophagus, oesophageal carcinoma.

  6. 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

  7. On lateral view: posterior mediastinum high density, projected over upper vertebral bodies and middle zone.
    Dilated proximal oesophagus.

    Posterior mediastinum mass collapsing the oesophagus?

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