A distinctive case of dysphagia.

A woman described a 2-year history of solid foods “getting stuck” once or twice per week. The sensation was not progressive, and she denied heartburn, regurgitation, weight loss, fever, hemoptysis and melena. She did not drink or smoke and had no history of muscle weakness or respiratory illness. On physical examination she appeared well nourished and was not jaundiced. Head, neck, respiratory and abdominal examinations were unremarkable. She had no lymphadenopathy, rash or focal neurologic findings. A chest radiograph (Fig. 1) suggested a large retrocardiac mass (black arrows) of uncertain origin. A CT scan of her chest with oral contrast medium (Fig. 2) showed a soft-tissue mass containing gas loculi (white arrow) 10 cm below the carina. A barium swallow (Fig. 3) revealed a diverticulum measuring 3 × 5 × 5 cm in the lower esophagus, just above the gastroesophageal junction, that contained food debris but no stricture, mass or mechanical obstruction. Upper gastrointestinal endoscopy (Fig. 4) confirmed the presence of a large diverticulum (yellow arrow) extending from the esophageal lumen (white arrow and white line) that contained undigested food debris but no evidence of erosion, inflammation or dysplasia. Because the patient’s symptoms were relatively minor, no treatment was initiated.