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DOI: 10.1055/s-0031-1291501
Thoracic spine osteophyte causing dysphagia
Publication History
Publication Date:
06 March 2012 (online)
A 65-year-old man, a chronic smoker and alcoholic with a diagnosed adenocarcinoma of the antrum of the stomach, was being further investigated because of dysphagia; endoscopic examination at the referring center showed a polypoid lesion in the mid esophagus. Positron emission tomography (PET) revealed increased uptake of fluorodeoxyglucose in this esophageal lesion. The possibility of a metastasis to the esophagus from the gastric malignancy was considered. However, biopsy from the esophageal lesion revealed features of chronic inflammation. A repeat gastroscopy was done and a polypoid lesion was observed in the mid esophagus ([Fig. 1]). Histopathological examination of the biopsy specimen from this lesion again revealed features of chronic inflammation. Contrast-enhanced computed tomography (CECT) of the chest with intravenous and a positive oral contrast revealed a dilated esophagus.
Radial endoscopic ultrasound examination of the esophagus revealed that the vertebral column was eroding into the posterior esophageal wall at the site of the lesion noted on endoscopy ([Fig. 2]). A repeat chest CECT, this time without oral contrast, showed that an anterior osteophyte from the thoracic vertebra was eroding into the esophagus ([Fig. 3]). It had not been possible to diagnose it in the previous CECT as during that procedure positive oral contrast was given which obscured the vertebral erosion into the esophagus ([Fig. 4]). A barium esophagogram also documented indentation of the posterior wall of the esophagus by a thoracic vertebra ([Fig. 5]).
Anterior osteophytes can occasionally impinge on the anteriorly located esophagus and can cause dysphagia [1] [2] [3] [4]. This commonly involves the hypopharynx or the cervical esophagus [1] [2] [3] [4]. Involvement of the thoracic esophagus is very rare because the thoracic esophagus is a relatively mobile structure in the posterior mediastinum that can be displaced without being compressed [5].
Endoscopy_UCTN_Code_CCL_1AB_2AC_3AH
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References
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