Presentation
Dysphagia and odynophagia
Patient Data
There is a deeply depressed, relatively flat lesion with contrast pooling, projecting outside the esophageal lumen. This is observed in the posterior wall of the distal esophagus, and it retains contrast after esophageal emptying, indicating a giant ulcer.
A fixed narrowing of the distal esophagus is noted adjacent to the ulcer, suggesting stricture formation.
The background mucosa appears unremarkable.
No signs of reflux are observed.
No hiatal hernia is present.
Case Discussion
Giant distal esophageal ulcers like this one are most frequently associated with CMV, HIV, or an ulcerated malignant lesion. The presence of adjacent stricture formation indicates a prolonged course of inflammation.
We lost follow-up with the patient and recommended a biopsy and further workup to differentiate our top differentials, which were CMV ulcer, HIV ulcer, or malignant ulcer.
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