Known congestive cardiac failure, gradually more shortness of breath ? fluid ? other cause
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Widening of the mediastinal contours by a gas filled esophagus, which can be followed down to the diaphragm.
Heart size normal. Lungs clear.
The gas filled dilated esophagus is consistent with achalasia. In some cases, an air fluid level may also be observed,
This is not to be confused with a gastric pull up. In this case, a thoracotomy would be evident and the widening of the mediastinum would not extend above the clavicles as in this case.