Extrinsic esophageal compression by the vertebral body

Area of Science:

• Gastroenterology
• Oncology
• Medical Imaging

Background:

• A 78-year-old female patient presented with a history of hypertension, diabetes, dyslipidemia, and revascularized ischemic heart disease.
• The patient was diagnosed with gastric adenocarcinoma in 2011, with suspected bilateral adrenal metastases, and underwent subtotal gastrectomy and palliative chemotherapy.

Observation:

• A follow-up gastroscopy in 2015 revealed a new, protruding, erosive mid-esophageal lesion.
• The lesion was initially suspected to be extrinsic compression or an ulcerated submucosal lesion and persisted over three months.
• The patient remained asymptomatic regarding esophageal symptoms.

Findings:

• Thoracoabdominal CT scans did not reveal bony abnormalities in the cervicothoracic spine or mediastinal changes.
• The persistent esophageal lesion, in the context of a gastric cancer history, prompted further investigation.

Implications:

• Endoscopic ultrasound was recommended to further evaluate the esophageal lesion.
• This case highlights the importance of vigilant surveillance for new esophageal findings in patients with a history of gastrointestinal malignancies.
• The diagnostic approach underscores the need for advanced imaging in characterizing indeterminate esophageal lesions.