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Flashcards in Cardiothoracic 2 Deck (11):

55-year-old woman presents with regurgitation chewed, digested food. Long history of dysphasia. Suspected diagnosis? Confirm with? Specific location? Treatment?

Pharyngeal (Zenker) diverticulum; barium swallow or endoscopy

Between lower pharyngeal constrictor and cricopharyngeal muscle

Transection of cricopharyngeal muscle to prevent uncontrolled contraction


45-year-old develops progressive SOB and weakness following respiratory illness. CXR shows a large heart shadow and congested lungs. ECHO reveals EF of 20% with moderate mitral regurgitation. Cardiac catheterization shows normal coronary arteries with poor ventricular contraction – likely diagnosis? Prognosis? Treatment?

Dilated cardiomyopathy (probably related to viral respiratory illness)

One third recovered, one third stay the same, one food dye

#Steroids, diuretics, immunosuppressives
#Beta blockers
#Heart Transplant


Second location of pulsion diverticulum?

Distal esophageal gastric junction (epiphrenic diverticulum)


Etiology of alcalasia? Treatment?

Loss of smooth muscle ganglionic cells of Auerbach plexus

Heller myotomy (100% effective) or transesophageal dilation (60% effective)


Location of squamous cell carcinoma of the esophagus?

Upper and middle third of the esophagus


Staging of esophageal tumors based on? Determine staging with what tests

Wall penetration and lymph nodes spread

Endoscopic ultrasound; CT scan


Treatment for cervical/upper third esophageal cancer?

#If persists, resection


Treatment for cancer in the middle of the esophagus?

Neoadjuvant chemotherapy, then surgical resection


Treatment for esophageal cancer in the lower third the esophagus?

Esophagectomy and proximal gastrectomy


Patient presents with severe dysphasia and difficulty swallowing. Weight loss if 50 lbs. Coughs constantly - work up? Likely reason for cough? Treatment?

Barium swallow, esophagoscopy, biopsy

Chronic aspiration from TE from tumor erosion into trachea

Cancer progressed too far for curative procedure – palliative care (feeding gastrostomy, stent, radiation, palliative resection)


Most likely tumor in the anterior mediastinum? Other tumors?

Thymoma (surgical resection)

Teratoma, lymphoma (Radiation and chemotherapy)