CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSISEISENBERG

1. 3Extrinsic Impressions on the
Thoracic Esophagus

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig GI 3-1 Normal
esophageal
impressions caused
by the aorta (short
arrow) and left main-
stem bronchus (long
arrow).

4. • Fig GI 3-2 Right aortic arch.

5. • Fig GI 3-3 Dysphagia aortica. Tortuosity of the descending thoracic aorta
produces characteristic displacement of the esophagus to the left. Note
the retraction of the upper esophagus to the right, caused by chronic
inflammatory disease, which simulates an extrinsic mass arising from the
opposite side.

6. • Fig GI 3-4 Aberrant left pulmonary artery. (A) Lateral
esophagram shows a smooth, ovoid soft-tissue mass
(M) lying between the distal trachea (T) and mid-
esophagus (E) and causing marked esophageal
narrowing. (B) Dynamic CT scan of the thorax shows
that the mass is actually the proximal portion of a
dilated left pulmonary artery (LPA), which has an
anomalous origin from the right pulmonary artery and
courses between the trachea (T) and the esophagus (E)
toward the left hilum. (SVC, superior vena cava.)4

7. • Fig GI 3-5 Calcified mediastinal lymph nodes at
the carinal level (arrow) cause a focal
impression on and displacement of the
esophagus.

8. • Fig GI 3-6 Squamous cell carcinoma of the
lung produces a broad impression on the
upper thoracic esophagus.

9. Fig GI 3-7 Squamous cell carcinoma of the lung impressing and
invading the mid-thoracic esophagus.

10. • Fig GI 3-8 Thoracic osteophyte. Posterior extrinsic defect on the esophagus
anterior to the T4 vertebral body. The osteophyte (*) was better shown on CT.
Note the osteophytes and the flowing ossification anterior to the lower thoracic
vertebral bodies (arrows) with preservation of the disk spaces.5

11. • Fig GI 3-9 Paraesophageal hernia impressing
the distal esophagus.