Presentation
Shortness of breath.
Patient Data
Age: 70 years
Gender: Male
From the case:
Ivor Lewis gastric pull-up
Frontal
- right paramediastinal structure with small air-fluid level just above the level of the tracheal bifurcation
- right-sided mediastinal surgical clips
- absent stomach bubble
From the case:
Ivor Lewis gastric pull-up
Axial C+ Chest
- 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.