A barium swallow study shows a smooth, broad-based filling defect in the mid-oesophagus with a 'shelf-like' edge and intact mucosa. The defect causes partial obstruction. A biopsy of the lesion shows smooth muscle bundles. The MOST characteristic barium finding distinguishing a leiomyoma from carcinoma of the oesophagus is:
- A Irregular mucosal destruction with shouldering effect
- B Smooth rounded intramural filling defect with intact overlying mucosa and obtuse angles with the oesophageal wall ✓
- C Apple-core appearance
- D Rat-tail appearance with proximal dilatation
Correct answer: B. Smooth rounded intramural filling defect with intact overlying mucosa and obtuse angles with the oesophageal wall
Explanation
Leiomyoma (GIST) of the oesophagus is a submucosal tumour — barium shows a smooth intramural filling defect with intact overlying mucosa, obtuse margins with the oesophageal wall ('bridge angle'), and eccentric narrowing without mucosal destruction. Carcinoma causes irregular mucosal destruction, 'apple-core' (annular carcinoma in colon), or 'rat-tail' narrowing seen in lye stricture or achalasia-associated carcinoma. Shouldering is a carcinoma feature.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.