An Unusual Cause of Esophageal Dysphagia
March 13, 2017
This Gastroenterology Clinical Image Challenge features an unusual cause of esophageal dysphagia detected by gastroscopy and endoscopic ultrasonography.
Gastroenterology Clinical Image Challenge Question: A 51-year-old man was referred to the hospital, presenting with a history of dysphagia for 3 months. Besides a history of smoking for 30 years, no abnormal symptoms or medical history were recorded, such as hypertension or weight loss. Laboratory examinations were also normal. Under gastroscopy, a 1.2 × 0.6-cm submucosal tumor (SMT) was found (Figure A, arrow). Interestingly, another horseshoe-shaped apophysis was located just near the lesion, occupying almost two-thirds of the circle of the esophagus (Figure A, arrowhead). Endoscopic ultrasonography (EUS) was carried out. Unexpectedly, the horseshoe effect resulted from external compression, and blood flow signal was detected around the esophagus. The unusual circular signal consisted of 2 parts in some levels, and one part clung to the lesion’s outer surface. These signals might come from some great vessels. Considering the risk with EUS-guided fine needle aspiration (EUS-FNA), CT angiography (CTA) was applied. CTA verified that the ascending aorta was divided into 2 branches. These 2 vessels surrounded the trachea and esophagus, and then joined together. Furthermore, the descending aorta ran along the right of the spine.
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