Case 12 Answer

First, does everyone see the abnormality now? You can see it superimposed over the right heart border on the frontal and posterior on the lateral. How high does it go? All the way up to the aortic arch. Is there air in it? No.

Several folks put hiatal hernia, but all of these things go against that - hernias don’t tend to go above the heart, the tend towards the left until they get huge and even then they flatten out along the diaphragm due to gravity. Plus they often contain air, especially when large.

So what does this correspond to? It’s the esophagus, but dilated (worse as you get to the diaphragm). So..

Answer: dilated esophagus associated with achalasia ( I wish I had the UGI but patient was a known achalasia patient in for post-dilation chest pain - no new findings today)

reference: https://radiopaedia.org/articles/achalasia