Correct!
4. Repeat thoracic CT performed with high-resolution technique
Upper endoscopy is reasonable and will likely be performed at some point to evaluate the patient’s suspected achalasia, but upper endoscopy is unlikely to assist in the evaluation of the patient’s shortness of breath and pulmonary function testing abnormalities. A repeat thoracic CT using intravenous contrast material is unlikely to provide incremental information to what is already known. However, repeating the thoracic CT using high-resolution technique, which includes post-expiratory and prone imaging, may well be of benefit. As there is no target for tissue sampling, cervical mediastinoscopy is not indicated. Finally, 68Ga-citrate scintigraphy, once occasionally used for the assessment of diffuse lung disease to distinguish pulmonary infection from other non-infectious causes of diffuse pulmonary disease, is now rarely employed for imaging the chest.
The patient underwent repeat enhanced thoracic CT (Figure 6). The study was not ordered as a high-resolution chest CT, however.
Figure 6. A-L: Representative images form axial thoracic CT displayed in lung windows shows an extremely dilated esophagus (e). Lower panel: video of thoracic CT in lung windows.
Which of the following findings on this thoracic CT scan may explain this patient’s shortness of breath? (click on the correct answer to be directed to the eleventh and final page)