2017-10-11 17:33:23 UTC

Image Challenge: A Large Changing Mass in the Esophagus

Oct. 11, 2017

What caused a heterogeneous hypoechoic lesion to originate in the muscularis propria of a 60-year-old patient?

Gastroenterology Clinical Image Challenge: A 60-year-old man presented with substernal chest pain and dysphagia lasting one month. The intensity of substernal chest pain increased when swallowing food without chills and fever. He had lost about 4.0 kg in the past two months.

Barium meal radiographic examination revealed a space-occupying lesion in the midesophagus (Figure A). Gastroscopy revealed a mass 3.0 cm in diameter, located in the esophagus 28.0 cm from the incisor teeth, with smooth surface and hard texture (Figure B). Endoscopic ultrasonography (EUS) showed the lesion was hypoechoic originating from muscularis propria (Figure C). A diagnose of esophageal leiomyoma was under consideration. Endoscopic enucleation was planned for one month later. Before the operation, endoscopy showed the mass became smaller and a longitudinal ulcer with a size of about 0.4 × 1.0 cm located in the surface. Repeat EUS showed a heterogeneous hypoechoic lesion originating from the muscularis propria and the border between the mass and the submucosa was unclear.

What is the diagnosis for the patient?

To find out the diagnosis, read the full case in Gastroenterology or download our Clinical Image Challenge app through AGA App Central, which features new cases each week. Sort and filter by organ, most popular or favorites. AGA App Central is available in both the Apple App Store and Google Play.