Esophageal pseudomass at the thoracic inlet on barium swallow: CT findings

PURPOSE

Our goal was to describe the CT findings in patients with an apparent mass at the thoracic inlet on barium swallow and to further explore its etiology by making appropriate measurements on CT.

METHOD

Barium swallows and CT scans of five patients with esophageal pseudomass were reviewed and compared with CT scans of 65 controls. Anteroposterior (AP) diameters of the thoracic inlet were measured, and the relationships of the esophagus to the trachea were determined on CT.

RESULTS

Absence of a demonstrable mass on CT in patients with an extrinsic impression on barium swallow was associated with narrowed AP diameter of the thoracic inlet (< 5 cm) and the esophagus to the left of the trachea. A significant correlation was observed between the AP diameter of the inlet and the position of the esophagus in relation to the trachea in control subjects (r = 0.52, p < 0.001); with diminished diameter, the esophagus is more frequently located to the left side of the trachea.

CONCLUSION

An apparent mass is simulated by lateral deviation of the lower cervical esophagus, due to diminished available space between the trachea and the esophagus in subjects with a narrow (< 5 cm) AP diameter of the thoracic inlet.

Bone scan detection of pelvic metastasis from pleural mesothelioma

The authors report a rare case of a symptomatic hematogenous osseous metastasis from a pleural mesothelioma. The lesion was initially detected by bone scintigraphy and was confirmed by MRI and subsequent open biopsy, despite a negative CT scan.