Images in Clinical Medicine

Kim Eagle, M.D., Editor

Adenocarcinoma of the Esophagus

William R. Brugge, M.D., and Michael J. Lee, M.D.

N Engl J Med 1994; 331:585September 1, 1994

• Slide

Article

Figure 1 Adenocarcinoma of the Esophagus.

The esophagus of a 69-year-old man with progressive dysphagia was visualized by several methods. Barium esophagography (Panel A) demonstrated a long, irregular distal stricture (arrows) just proximal to the gastroesophageal junction. Computed tomographic scanning (Panel B) showed a thickened esophageal wall (large arrow) and an enlarged paraaortic node (small arrow); Ao denotes aorta. Endoscopy (Panel C) revealed narrowing of the distal esophagus (solid arrows); a biopsy of the nodule (open arrow) demonstrated adenocarcinoma. Endoscopic ultrasonography of the distal esophagus (Panel D), a new technique, showed several structures in cross-section, including the aorta, an irregular hypoechoic mass (arrows and V-shaped markers) that extended through the muscularis into the adventitia adjacent to the right pulmonary artery (RPA), and an enlarged adjacent lymph node (LN). The tumor was resected. Ordinarily, the diagnosis and management of esophageal cancer do not require all four of these procedures.

Kim Eagle, M.D.

William R. Brugge, M.D.
Michael J. Lee, M.D.
Massachusetts General Hospital, Boston, MA 02114