Oesophageal carcinoma

Case contributed by RMH Report Writing

Presentation

Dysphagia and weight loss.

Patient Data

Age: 90
Gender: Male
X-ray

Chest radiograph

Heart size is normal.

Widened superior mediastinal on the frontal view. A mediastinal mass or lymph node mass is most likely.

The lungs and pleural spaces are clear.

Degenerative changes in the thoracic spine with no suspicious or destructive osseous lesion noted.

Mediastinal evaluation with cross sectional imaging is indicated.

CT

CT Neck and chest

A large mass circumferentially encases the upper thoracic oesophagus. It extends from the level of the thoracic inlet down to approximately the level of the carina. The mass projects into the posterior wall of the trachea but does not compromise the lumen.

Medially, the mass has breached the right apical pleura area of localised lymphangitis in the right upper lobe. Several locules of air are contained in this most medial component consistent with local perforation. The left margin of the tumour contacts the left subclavian artery.

There is a 12 x 10 mm precarinal lymph node, suspicious. Several sub centimetre mediastinal nodes visible; paratracheal and AP window.

A 6mm pulmonary nodule is visible abutting the pleura in the lateral basal segment of the right lower lobe. There are no regions of consolidation in the remainder of the chest. No pleural effusions or fissural thickening.

The thyroid is unremarkable. There is no significant cervical adenopathy. Moderately extensive dental disease.

Extensive degenerative change throughout the thoracic spine. The upper abdominal organs are unremarkable.

Conclusion: Proximal thoracic oesophageal malignancy with contained local perforation and spread beyond the mediastinum. Likely mediastinal lymph node and pulmonary metastases.

 

Case Discussion

Unresectable carcinoma of the oesophagus

These tumours tend to present with increasing dysphagia, initially to solids and progressing to liquids as the tumour increases in size, obstructing the lumen of the oesophagus.

The 5-year mortality depends on the stage of the tumour. Unfortunately, most cases present with regional or distant metastatic disease (30% and 40%), respectively.

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Case information

rID: 38457
Case created: 20th Jul 2015
Last edited: 12th Nov 2016
Tag: rmh
Inclusion in quiz mode: Included

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