On barium swallow, a patient shows a 'rat-tail' or 'shoulder' appearance in the mid-esophagus with abrupt irregular shouldering of the lumen. This appearance is characteristic of:
- A Achalasia cardia with smooth tapering
- B Carcinoma esophagus with mucosal destruction ✓
- C Diffuse esophageal spasm with tertiary contractions
- D Esophageal web in Plummer-Vinson syndrome
Explanation
The 'rat-tail' or 'shouldering' appearance on barium swallow represents abrupt, irregular shelf-like margins at the upper and lower borders of the tumor, causing an overhanging edge that looks like shoulders — classic for carcinoma of the esophagus. This reflects the infiltrating tumor destroying the mucosa and creating an irregular filling defect. Achalasia shows smooth tapering ('bird-beak') at the lower esophageal sphincter. Diffuse esophageal spasm produces a 'corkscrew' esophagus from uncoordinated tertiary contractions. Esophageal webs are thin, shelf-like projections in the upper esophagus (post-cricoid) seen in Plummer-Vinson.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.