PROBLEM
A 76-year-old man complains of chest fullness and discomfort. What is your interpretation of this view of his chest?

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ANSWER
The correct diagnosis is achalasia of the esophagus. When the esophagus dilates massively, it presents to the right side of the mediastinum in this curvilinear fashion. Note also the air-fluid level at the thoracic inlet. A similar appearance is sometimes seen in long-standing carcinoma of the distal esophagus.

This series of diagnostic quizzes that challenge your ability to read a variety of x-ray films is edited by Dr. Keats, alumni professor of radiology at the University of Virginia School of Medicine in Charlottesville. Emerg Med 38(9):61-62, 2006