Teaching Case

Six months hystory of cough

A 63 year old male presented with a six month history of cough. Chest radiograms revealed a retrocardiac calcified area wich was noted but not definitely localized. CT showed an esophageal wall tickening containing multiple coarse irregular calcifications. Double contrast esophagogram was performed and demonstrated a filling defect approximately 7cm. in lenght, localized at the middle and lower third of the esophagus that exibited calcifications. Esophagograms demonstrated the intramural nature of the lesion by showing the absence of irregularity of the overlying mucosa or obstruction to the flow of barium. Endoscopy did not reveal further findings.

Leiomyoma is the most common benign tumor of the esophagus. Esophageal leiomyoma is rarely multiple and may appear in any part of esophagus, but the lower third is the commonest site. This tumor may be either peduncolated or intramural. The presenting syntom is variable, and the majority presenting with dysphagia, retrosternal pain, or reflux, although literature reports states that 50% are asyntomatic. Esophageal leiomyoma can develope calcifications that probably occurs with the advanced age. Calcified esophageal leiomyoma is predominantly located in the distal esophagus or the cardia. Their usual presentation is as a smoothly rounded or lobulated retrocardiac mass containing multiple coarse irregular calcifications. The intramural nature, and the intact overlying mucosa also provide criteria for an accurate diagnosis. The two essential investigations for diagnosis of esophageal leiomyoma are esophagograms and esophagoscopy. Calcified esophageal leiomyoma can be also revealed through routine chest radiograms. CT also play an important role for assessing the exact extension and size of these tumors. Treatment of these tumors should usually be by their removal, and prognosis is excellent in most of cases treated; malignant changes are infact a rare complication of these tumors.