Dr. Edward H. Eliscu: This is the first Massachusetts General Hospital admission for this 56-year-old white male alcoholic. The patient was relatively well until three months prior to admission when he first noted difficulty in swallowing. Dysphagia became progressive over the next three months, first occurring with solid food and then with liquids. After eating, he felt that food was stuck in his chest causing nausea, which was relieved by vomiting. Occasionally, specks of blood were noted in vomitus containing undigested food. The patient denied having had any alcohol during the past eight months. He had lost no weight. Physical examination was not contributory. An upper gastrointestinal tract examination was performed (Fig 1 and 2).
Dr. Laurence L. Robbins: Dr. Pfister, what is your opinion of this case?Dr. Richard C. Pfister: The roentgenograms reveal two areas of interest: one is a large axial hiatus hernia; the other is