A barium swallow of a 50-year-old male with progressive dysphagia shows a smooth, broad-based filling defect in the mid-oesophagus at the level of the carina that appears as an extrinsic impression without mucosal destruction. This is most likely caused by:

• A Oesophageal carcinoma
• B Subcarinal lymph node enlargement ✓
• C Leiomyoma of the oesophagus
• D Pharyngeal pouch

Explanation

Extrinsic compression of the mid-oesophagus at the carinal level with smooth mucosal preservation on barium swallow is characteristic of enlarged subcarinal lymph nodes (commonly from lymphoma, tuberculosis, or metastatic disease), which lie immediately posterior to the carina. Oesophageal carcinoma shows mucosal destruction with irregular margins. Leiomyoma is an intramural lesion appearing as a smooth intraluminal filling defect with intact overlying mucosa, typically in the lower two-thirds. A pharyngeal pouch (Zenker's diverticulum) is at the pharyngo-oesophageal junction.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.