Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors
The patient is a 61 year old man admitted to the psychiatry service for depression. During the hospitalization the patient reported a three year history of dysphagia and occasional right sided chest pain not clearly associated with exertion. He first noted difficulty chewing and swallowing turkey on Thanksgiving Day. The symptoms were intermittent thereafter and involved solid foods but not liquids. His chewing and swallowing difficulty abated for a year but returned one year later and persisted until presentation. The patient denied fevers, breathlessness, chest pain, limb weakness, speech abnormalities, numbness or visual changes. Past medical history included depression treated with citalopram, hyperlipidemia treated with simvastatin, and tobacco abuse. Exam was notable for obesity, normal vital signs, clear chest, and non-focal neurologic exam.
Chest radiographs are shown below: