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Image challenge: An unexpected thoracic finding in a patient with COVID-19

What caused monstrous esophageal dilatation with sigmoid shape in a patient with a history of epigastric discomfort?
Image Challenge 10122021 1920x1080
Image Challenge 10122021 1920x1080

Gastroenterology image challenge: A 75-year old woman presented to the emergency department with a history of epigastric discomfort and rapidly worsening thoracic pain. She had no fever or cough. On physical examination, she appeared overweight (102 kg, height 162 cm). Laboratory examination revealed normal cardiac troponin levels and slight increase in inflammatory markers (C-reactive protein and neutrophil-lymphocyte ratio). As a nasal screening swab was positive for coronavirus 2019 (COVID-19) infection, she was transferred to the COVID isolation ward. A subsequent computed tomography scan of the chest showed no interstitial lung disease. However, the presence of a monstrous esophageal dilatation with sigmoid shape and dislodgment of the surrounding structures was seen. The esophagus appeared full of solid content compatible with accumulated undigested food residues (figure A–C).

The patient was then referred to our gastroenterology unit. Upper endoscopy was performed under general anesthesia with endotracheal intubation. Endoscopic esophageal findings are shown in figure D.

What is the most likely diagnosis and how should it be managed?

To find out the diagnosis, read the full case in Gastroenterology.

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