Esophageal carcinoma

Heart size is normal.

Widened superior mediastinal on the frontal view. A mediastinal mass or lymph node mass is most likely.

The lungs and pleural spaces are clear.

Degenerative changes in the thoracic spine with no suspicious or destructive osseous lesion noted.

Mediastinal evaluation with cross sectional imaging is indicated.

A large mass circumferentially encases the upper thoracic esophagus. It extends from the level of the thoracic inlet down to approximately the level of the carina. The mass projects into the posterior wall of the trachea but does not compromise the lumen.

Medially, the mass has breached the right apical pleura area of localized lymphangitis in the right upper lobe. Several locules of air are contained in this most medial component consistent with local perforation. The left margin of the tumor contacts the left subclavian artery.

There is a 12 x 10 mm precarinal lymph node, suspicious. Several sub centimeter mediastinal nodes visible; paratracheal and AP window.

A 6mm pulmonary nodule is visible abutting the pleura in the lateral basal segment of the right lower lobe. There are no regions of consolidation in the remainder of the chest. No pleural effusions or fissural thickening.

The thyroid is unremarkable. There is no significant cervical adenopathy. Moderately extensive dental disease.

Extensive degenerative change throughout the thoracic spine. The upper abdominal organs are unremarkable.

Conclusion: Proximal thoracic esophageal malignancy with contained local perforation and spread beyond the mediastinum. Likely mediastinal lymph node and pulmonary metastases.