Image Based Question-71104

A patient presented with dysphagia to solids and liquids.Barium Swallow examination is shown.What can be the most probable diagnosis?

A. Esophageal Ring

B. Esophageal Carcinoma

C. Esophageal Tear

D. Achalasia Cardia

Correct Answer » B Explanation

Ans:B. Esophageal Carcinoma.

Image demonstrate an irregular, somewhat nodular filling defect (white arrows) stretching for a considerable part of the distal esophagus, narrowing the lumen. There is a shelf-like defect approximately where the tumor begins (red arrows).

Esophageal Carcinoma

Predisposing factors for carcinoma esophagus:

For adenocarcinoma:

• Chronic gastric reflux (Barrett’s esophagus)

For squamous cell carcinoma:

• Alcohol

• Cigarette

• Mucosal damage from physical agents: long term ingestion of hot liquids, lye (caustic ingestion), radiation induced strictures and chronic achalasia

• Other ingested carcinogens: Nitrates, nitrites, nitrosamines, smoked opiates and fungal toxins in packed vegetables.

• Plummer-Vinson-paterson-kelly syndrome (esophageal web + glossitis + Iron deficiency)

• Tylosis palmaris et plantaris (congenital hyperkeratosis and pitting of palms and soles)

• Human papillomavirus

• Bulimia (repeated microtrauma due to vomiting, may contribute to the malignant transformation of the esophageal tissue)
  Esophageal diverticula