Frontal (image 1) and lateral (image 2) radiographs of the a | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Frontal (image 1) and lateral (image 2) radiographs of the airway in a child who ingested a key shows the key lodged in the proximal esophagus (arrow). Large ingested foreign bodies in the lodge in 3 different locations within the esophagus: at the upper esophageal sphincter, in the mid esophagus at the level of the aortic arch, and at the distal esophagus at the lower esophageal sphincter. #ThoraxThursday #ThoracicThursday

Esophageal heterotopic gastric mucosal patches (HGMP), also known as cervical inlet patches (CIP), is a rare but underdiagnosed condition characterized by the presence of salmon-colored, velvety mucosa located in the proximal esophagus, distal to the upper esophageal sphincter. The incidence of CIP ranges from 3% to 10% in adults, and its endoscopic appearance is characterized by a flat or slightly raised salmon-colored patch. In this case, we report a 78-year-old man who presented with symptoms of laryngopharyngeal reflux and dysphagia. An esophagogastroduodenoscopy showed a flat area of salmon-colored patch between 17 and 20 cm from the incisors, suggestive of a CIP complicated by stricture. The biopsy results showed an oxyntic-type mucosa lined with columnar cells consistent with an inlet patch. Esophageal dilation was done with a savory dilator with no resistance at 18 mm. The patient was placed on maintenance acid suppression therapy with proton-pump inhibitors and reported complete resolution of symptoms at the 1-month follow-up.

AP images from an esophagram display a plastic bottle cap (arrow) lodged within the proximal esophagus. Plastic bottle caps are relatively common ingested foreign bodies, especially in adolescents who play with caps in their mouths. They often become lodged in the esophagus, typically near the aortic arch, and are removed endoscopically when lodged.

Esophagram in an adolescent with recurrent emesis and achalasia shows narrowing of the distal esophagus just proximal to the gastroesophageal junction. There is a mild "birds beak" appearance (arrow) of the esophagus at this level. Achalasia is an esophageal motility disorder caused by dysfunction of the mesenteric plexus leading to fix contraction of the lower esophageal sphincter.

This patient has difficulty swallowing foods aka dysphasia. On endoscopy he had a blind pouch adjacent to his upper esophageal sphincter (sphincter at the very beginning of the esophagus). This blind pouch/outpouching is called a Zenker's Divericulum which occurs due to a defect in the muscular wall of the esophagus. Patient sometimes complain of really bad breath and this is because food hangs around in the pouch. The picture is a barium swallow showing this outpouching. Surgery is the best treatment. @gastrohepatodoc

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?