On a barium swallow, a smooth filling defect in the mid-oesophagus on two walls with normal mucosa overlying it ('T-sign' or 'cervical oesophageal web' excluded) and pulsatile appearance suggests:

• A Extrinsic vascular compression (dysphagia lusoria) ✓
• B Carcinoma of the oesophagus
• C Leiomyoma of the oesophagus
• D Achalasia cardia

Explanation

Dysphagia lusoria is caused by an aberrant right subclavian artery (arteria lusoria) arising as the last branch of the aortic arch and crossing behind the oesophagus. On barium swallow, it produces a smooth extrinsic oblique or transverse compression of the posterior wall of the mid-oesophagus, which may appear pulsatile under fluoroscopy. Leiomyoma causes a smooth intramural filling defect with sharp borders. Carcinoma causes irregular mucosa and shouldering. Achalasia causes smooth tapering at the cardia.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.