Cáceres’ Corner Case 244 – SOLVED

Dear friends I am presenting today the pre-op PA chest radiograph of a 40-year-old man.
What do you see?

More images will be shown on Wednesday.

Click here to see more images

Dear friends, showing today images of the barium swallow. What do you think?

The answer will be published on Friday 🙂


Click here to see the answer

Findings: PA radiograph shows convexity of the middle aspect of the right mediastinal border (A, arrow). There is a double contour in the opposite side (A, red arrow). These two lines conform the limits of a rounded mass which is better seen in the penetrated AP radiograph (B, arrows).

An outside CT (not available) confirmed a middle mediastinal mass. Esophageal diverticulum was included in the differential diagnoses (??) and for this reason a barium swallow was done.

AP view of the esophagogram shows a large mass deforming the esophagus (C, circle). Oblique view demonstrates the typical appearance of a submucosal mass of the esophageal wall (D, circle). Endoscopy confirmed an intact mucosa.
A large intramural esophageal tumor that looks like an alien was resected (E, insert)

Final diagnosis: leiomyoma of esophagus.
 
Congratulations to Traidor who made the diagnosis before the barium study and to Genchi Bari, after.

Teaching point: I am showing this case to review basic concepts of paleo-radiology (before CT), when we used to classify GI tumors according to the appearance of the filling defect in the barium column.

A represents an intraluminal mass (polyps and carcinomas, usually)

B is the typical appearance of a submucosal intramural mass (looks like an extrapulmonary lesion in the chest radiograph). Usually due to benign spindle-cell tumors or duplication cyst. Rarely metastasis.

C represents the deformity secondary to an extrinsic mass

20 thoughts on “Cáceres’ Corner Case 244 – SOLVED

  1. Convex outward bulge of right mediastinal border,it is silhoutting the right mediastinal border .opacity in left reterocardiac location with parallel line to dscending thoracic aorta.
    lungs are clear.no pleural effusion.bones normal.
    patholgy in anterior and middle mediastinum-1.vascular 2. mass-nodes.

    Like

    1. 2.44There is a prominent curve at the anatomic position of ascenting artery,as long as at the anatomic position of descending artery.There is also increased angle of Carina…
      Dd icludes 1.De Bakey aneurysm type 1(Stanford A),and diatasis of left cardiac chamber
      . 2.lymphadenopathy, RT portal and subcarinal,with diatasis or elicosis of descending artery

      Like

  2. Good morning!!

    There is a double contour next to the descending aorta and the paraspinal interface is separated from the spine. There is an increased density proyected over the right hilum, but the hilums are well posicionated.

    I need a lateral x-ray to consider vascular vs posterior mediastinal lesion.

    Like

  3. Hilum overlay positive so anterior or posterior mediastinal mass..silhouette not well appreciated,,need a lateral xray to look out for the location

    Like

  4. Agree with above comments – soft tissue mass with very smooth margin. Hilum overlay seen. Would like a lateral XR and/or CT please.

    Like

  5. Right hilum overlay seen, widenig of carinal angle, descending aorta double contour. It looks like an aorta aneurism type 1 De Bakey… but medial Mediastinal mass can not be rulled out!

    Like

  6. GOOD MORNING SIR

    The barium swallow image shows
    1. Extrinsic impression of the mid esophagus with displacement of esophagus towards right side – likely submucosal esophageal lesion ( benign tumor/ infection).

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.