Correct!
2. The abnormal mediastinal contour affects the ayzgoesophageal recess
The frontal chest radiograph (Figure 1A) shows an abnormal mediastinal contour bulge that causes an outward convexity of along the mid-portion of the ayzgoesophageal recess. Normally the ayzgoesophageal recess is a mediastinal interface created by contact of the medial right lung with the right mediastinum extending cranially from the arch of the azygos vein caudally to the diaphragm. The mediastinum in this location typically contains the azygos vein, esophagus, small lymph nodes, and mediastinal fat, the former two contributing to the name of the ayzgoesophageal recess, with the azygos vein (and pleural covering the thoracic spine) often creating the posterior border, and the esophagus the medial border, of the ayzgoesophageal recess, although the anatomy may vary substantially from patient to patient. Typically the ayzgoesophageal recess describes a concave configuration with the adjacent right lung, or often a gentle “S”-shaped curve may be seen (Figure 3).
Figure 3. Frontal chest radiographs in 2 separate patients showing the normal interface created between the medial right lung and the medial right mediastinal region, referred to as the ayzgoesophageal recess. In these patients, the ayzgoesophageal recess describes a gentle, “S”-shaped curve.
Abnormalities of the ayzgoesophageal recess present as outward, convex “bulges” of this line, which may be noticeably focal in some circumstances. The right paratracheal stripe and right para-aortic stripe both appear normal in this patient. The aorto-pulmonary window and pre-aortic spaces also both appear normal and both are left-sided structures.
Which of the following is the most appropriate next management step for this patient? (Click on the correct answer to proceed to the fourth of nine pages)