Presentation
Long-standing dysphagia to liquid and recently to solid food with respiratory complaints.
Patient Data
There is a circumferential, irregular, and asymmetric increase in mural thickness (up to about 1.4 cm in maximum size, unilaterally on the anterior aspect) of the thoracic esophagus from D5 up to D9 level, with about 10.1 cm in total length of the involved segment. Marked surrounding stranding with luminal dilatation of the involved segment is seen.
The involved segment encases the adjacent thoracic aorta more than 90 degrees, and tir-angular fat between the esophagus, aorta, and spine is lost.
The left bronchus is also slightly displaced anteriorly by an adjacent disease segment, suggesting their invasion.
Few enlarged and matted lymph nodes (non-separable from the anterior involved wall of the esophagus) are noted in the pre-esophageal region (opposite to D7/8 level), with the largest one measuring about 1.5 x 2.5 cm.
Consolidation with the air-bronchogram of the right middle lobe is seen; however, the lobar bronchus appears patent with a differential middle lobe collapse.
Case Discussion
CT findings are of an esophageal wall squamous cell carcinoma (biopsy proven) with regional lymphadenopathy and most likely aortic and left bronchial invasion (cT4bN2M0)-stage IVA as described above, along with evidence of right middle collapse.
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