Dr. Richard M. Heller: This was the first hospital admission of this 48-year-old woman. Two years ago she began to complain of vague substernal discomfort, made worse by eating spicy foods. She was, however, able to swallow solids without difficulty. Results of physical examination and laboratory studies were within normal limits. Barium study of the upper gastrointestinal tract was performed (Figure).
Dr. Laurence L. Robbins: How would you interpret these roentgenograms, Dr. Dreyfuss?Dr. Jack R. Dreyfuss: There is a crescentshaped pressure defect against the column of barium in the lower portion of the esophagus, very suggestive of an intramural, extramucosal tumor. The leading diagnostic possibility would be spindle-cell tumor. However, there are other entities that can look like this. It is conceivable that a mediastinal lymph node is pressing against the esophagus. It is also possible that there is a duplication or an enteric cyst of the lower