Question:medium
A barium swallow examination is shown below. What is the most probable diagnosis?
A barium swallow examination is shown below. What is the most probable diagnosis?
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Irregular narrowing with shouldered margins, not a smooth taper.
Updated On: Jun 23, 2026
- Esophageal carcinoma
- Esophageal ring
- Esophageal tear
- Achalasia cardia
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The Correct Option is A
Solution and Explanation
Pattern recognition on barium: the single most useful sign here is shouldering. An irregular, ragged narrowing with abrupt overhanging margins and a destroyed mucosal line screams malignancy, that is oesophageal carcinoma.
Compare the look-alikes. Achalasia is the smooth, symmetric, tapering bird-beak at the lower end with a hugely dilated oesophagus above and an air-fluid level, the geometry is gentle, not ragged. A Schatzki ring is a fine, shelf-like, smooth concentric band right at the gastro-oesophageal junction, often linked to dysphagia for solids. A tear or perforation does not narrow the lumen at all, you instead see contrast spilling outside it.
Add the epidemiology: a mid-oesophageal lesion is most often squamous cell carcinoma, while lower-third lesions are more often adenocarcinoma. So the irregular shouldered mid-oesophageal stricture is the cancer. Ref: Bailey & Love, 27th ed.
Compare the look-alikes. Achalasia is the smooth, symmetric, tapering bird-beak at the lower end with a hugely dilated oesophagus above and an air-fluid level, the geometry is gentle, not ragged. A Schatzki ring is a fine, shelf-like, smooth concentric band right at the gastro-oesophageal junction, often linked to dysphagia for solids. A tear or perforation does not narrow the lumen at all, you instead see contrast spilling outside it.
Add the epidemiology: a mid-oesophageal lesion is most often squamous cell carcinoma, while lower-third lesions are more often adenocarcinoma. So the irregular shouldered mid-oesophageal stricture is the cancer. Ref: Bailey & Love, 27th ed.
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