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Because it displays such a variety of roentgenographic patterns, carcinoma of the esophagus is mimicked by many other esophageal lesions. Often enough, however, the presence of one or another of its telltale features, such as rigidity, nodularity, or shelf-like margin, leaves little doubt about the diagnosis. This is particularly true when the ominous symptom of recent progressive dysphagia is elicited.
But the diagnosis of esophageal carcinoma is not always easy. To begin with, in the asymptomatic patient, the barium and the roentgenologist's eye move down the esophagus so quickly that a sizable tumor may be missed. It is amazing how large an esophageal lesion may become without causing symptoms if the wall is not extensively infiltrated. Generally, involvement of about one half the circumference is required to produce dysphagia, according to an oral communication from Dr. Richard Schatzke, in 1958. Figure 4 shows a small asymptomatic carcinoma in a patient
Wiot JW, Felson B. Radiographic Differential Diagnosis. JAMA. 1973;226(13):1548-1552. doi:10.1001/jama.1973.03230130036012