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.
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Dear friends, showing today images of the barium swallow. What do you think?
The answer will be published on Friday 🙂
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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