Thoracic spine osteophyte causing dysphagia.

A 65-year-old man, a chronic smoker and alcoholic with a diagnosed adenocarcinoma of the antrum of the stomach, was being further investigated because of dysphagia; endoscopic examination at the referring center showed a polypoid lesion in the mid esophagus. Positron emission tomography (PET) revealed increased uptake of fluorodeoxyglucose in this esophageal lesion. The possibility of a metastasis to the esophagus from the gastric malignancywas considered. However, biopsy from the esophageal lesion revealed features of chronic inflammation. A repeat gastroscopy was done and a polypoid lesion was observed in the mid esophagus (●" Fig.1). Histopathological examination of the biopsy specimen from this lesion again revealed features of chronic inflammation. Contrast-enhanced computed tomography (CECT) of the chest with intravenous and a positive oral contrast revealed a dilated esophagus. Radial endoscopic ultrasound examination of the esophagus revealed that the vertebral column was eroding into the posterior esophageal wall at the site of the lesion noted on endoscopy (●" Fig.2). A repeat chest CECT, this time without oral contrast, showed that an anterior osteophyte from the thoracic vertebrawas eroding into the esophagus (●" Fig.3). It hadnot beenpossible todiagnose it in theprevious CECT as during that procedure positive oral contrast was given which obscured the vertebral erosion into the esophagus (●" Fig.4). A barium esophagogram also documented indentation of the posterior wall of the esophagus by a thoracic vertebra (●" Fig.5). Anterior osteophytes can occasionally impinge on the anteriorly located esophagus and can cause dysphagia [1–4]. This commonly involves the hypopharynx or the cervical esophagus [1–4]. Involvement of the thoracic esophagus is very rare because the thoracic esophagus is a relatively mobile structure in the posterior mediastinum that can be displaced without being compressed [5].