A 47-year-old man comes to the office due to dysphagia. The patient says that it feels like food has been getting stuck in his throat over the last month. He has changed his diet to accommodate his symptoms and now consumes only liquid foods. The patient has a long history of postprandial heartburn that sometimes awakens him from sleep. He has treated his heartburn with over-the-counter antacids but usually only has partial relief. A thoracic CT image near the level of the aortic arch is shown below. This patient's symptoms are most likely related to pathology involving which of the following structures?

Question

A 47-year-old man comes to the office due to dysphagia.  The patient says that it feels like food has been getting stuck in his throat over the last month.  He has changed his diet to accommodate his symptoms and now consumes only liquid foods.  The patient has a long history of postprandial heartburn that sometimes awakens him from sleep.  He has treated his heartburn with over-the-counter antacids but usually only has partial relief.  A thoracic CT image near the level of the aortic arch is shown below.  This patient's symptoms are most likely related to pathology involving which of the following structures?

Quizplus · Accepted Answer

11ec160b_357f_50a9_9249_45637f658ddd_MD0001_00 This patient's prolonged history of heartburn is suggestive of gastroesophageal reflux disease (GERD), a condition that affects the esophagus. Dysphagia (ie, difficulty swallowing) is common in patients with longstanding GERD and can be caused by impaired peristalsis, esophageal inflammation/stricture, or malignancy. In the thorax, the esophagus courses between the trachea and vertebral bodies and is typically collapsed with no visible lumen. The trachea serves as a good landmark because the radiolucency of the air in this structure allows one to differentiate it from the esophagus posteriorly and the great vessels anteriorly (Choice C). (Choice A) This is the descending aorta. (Choice D) This is the arch of the azygos vein as it curves over the right main bronchus to join with the superior vena cava. The azygos vein itself ascends along the thoracic vertebral column to the right of the esophagus. (Choice E) This is a section of the top of the pulmonary artery as it passes underneath the aortic arch. Educational objective: The esophagus is located between the trachea and the vertebral bodies in the superior thorax. It is typically collapsed with no visible lumen on CT images of the chest.

A 47-Year-Old Man Comes to the Office Due to Dysphagia