Ivor Lewis gastric pull-up

Case contributed by Chris Newman
Diagnosis certain

Presentation

Shortness of breath.

Patient Data

Age: 70 years
Gender: Male
x-ray
  • right paramediastinal structure with small air-fluid level just above the level of the tracheal bifurcation
  • right-sided mediastinal surgical clips
  • absent stomach bubble
ct
  • the CT confirms the fluid-filled structure entered within the right posterior mediastinum in keeping with a history of gastric pull-up surgery
  • the fluid extends superiorly toward the larynx, which places the patient at risk of aspirating

Case Discussion

The Ivor Lewis gastric pull-up is a classic chest x-ray case whereby the thoracic opacity can mimic pulmonary or mediastinal masses as well as pulmonary infection.

The surgical clips, air-fluid level and absence of the normal gastric bubble beneath the left hemidiaphragm are a few clues to suggest that this appearance is an expected post-procedural finding.

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