A 75-year-old woman with gastroesophageal reflux disease (see GERD discussion) and Barrett's changes in the distal esophagus was found to have high-grade dysplasia on a yearly surveillance upper endoscopy. Endoscopic mucosal resection was performed. Path results showed foci of adenocarcinoma. Diagnostic workup showed no evidence of nodal or metastatic spread.
The hilar views show the relationship of the esophagus to surrounding mediastinal structures. The esophagus descends through the posterior mediastinum to the right of the aortic arch and finally lies anterior to the descending thoracic aorta at the diaphragm. It is bounded anteriorly by the trachea and then by the left atrium. The thoracic duct crosses from right to left between the upper third of the esophagus and the vertebral column. The blood supply of the lower esophagus comes from the bronchial arteries, small aortic branches, and ascending branches of the inferior phrenic and left gastric arteries.
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