Presentation
Gastro-esophageal reflux with progressive dysphagia for the solids in a patient with Down syndrome.
Patient Data
The chest x-ray shows a convex opacity overlapping the right mediastinum most likely due to dilated esophagus. Aerated splenic flexure with no visibility of the gastric bubble. Both lungs are clear. No pleural effusion is seen.
The fluoroscopic exam shows marked dilatation of the proximal and mid-esophagus with a smooth stricture of the distal esophageal third above a sliding hiatus hernia with a delay in the passage of contrast into the stomach.
Case Discussion
The clinical history and the fluoroscopic examination are most consistent with a peptic esophageal stricture due to gastro-esophageal reflux disease in a patient with a hiatus hernia.